System and method for spinal correction

ABSTRACT

Methods of correcting a spinal deformity, including securing a first rod on a first side of a spine, securing an anchor on a second side of a spine, securing a lateral coupling between the rod and the anchor, translating and/or derotating the spine and securing a second rod on a second side of the spine to provide secondary stabilization to the spine.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority under 35 U.S.C. 120 to, and is acontinuation-in-part of U.S. application Ser. No. 13/865,775, filed Apr.18, 2013, entitled, “Spinal Correction and Secondary Stabilization”which is a continuation-in-part of U.S. Ser. No. 13/297,841, filed Nov.16, 2011, entitled, “Spinal Correction and Secondary Stabilization.”This application also claims priority under 35 U.S.C. 120 to, and is acontinuation-in-part of U.S. application Ser. No. 14/029,610, filed Sep.17, 2013, entitled, “Transverse Coupler Adjuster Spinal CorrectionSystems and Methods” the entire contents of each of which areincorporated herein by reference.

INCORPORATION BY REFERENCE OF ADDITIONAL DISCLOSURES

Additional examples of system components and corrective methodology inaccordance with various embodiments of the present invention are setforth in U.S. App. Pub. 2010/0318129, filed Jun. 16, 2009 and entitled“Deformity Alignment System with Reactive Force Balancing”; U.S. App.Pub. 2010/0249837, filed Mar. 26, 2009 and entitled “Semi-ConstrainedAnchoring System”; U.S. App. Pub. 2011/0054536, filed Sep. 1, 2010 andentitled “Growth Directed Vertebral Fixation System with DistractibleConnector(s) and Apical Control”; U.S. Pat. No. 7,658,753, issued Feb.9, 2010 and entitled “Device and Method for Correcting a SpinalDeformity”; and U.S. App. Pub. 2009/0012565, filed on Jun. 5, 2008 andentitled “Medical Device and Method to Correct Deformity,” the entirecontents of each of which are incorporated herein by reference.

BACKGROUND

Various systems have been proposed for treating spinal deformities suchas scoliosis, spondylolisthesis, and a variety of others. Primarysurgical methods for correcting a spinal deformity utilizeinstrumentation to correct the deformity as much as possible andseparate implantable hardware systems to rigidly stabilize and maintainthe correction.

SUMMARY

Some aspects relate to a spinal correction system for correcting aspinal deformity of a patient's spinal column, the patient's spinalcolumn including a first vertebra and a second vertebra and having afirst side and a second side opposite to the first side, the spinalcorrection system comprising: a first rod adapted to extendlongitudinally along the first side of the spine of the patient; asecond rod adapted to extend longitudinally along the second side of thespine of the patient; a transverse coupler adapted to couple the firstrod and the second rod such that the first rod and the second rod areconstrained against substantial lateral translation relative to oneanother; a first rod anchor adapted to be fixed to the first vertebra ofthe spine at an inferior position relative to the transverse coupler,the first rod anchor coupled to the first rod such that the first rod issecured against substantial lateral translation relative to the firstrod anchor while allowing the first rod to change alignment relative tothe first rod anchor; a second rod anchor adapted to be fixed to thesecond vertebra of the spine at a superior position relative to thetransverse coupler, the second rod anchor coupled to the first rod suchthat the first rod is secured against substantial lateral translationrelative to the first rod anchor while allowing the first rod to changealignment relative to the second rod anchor; a third rod anchor adaptedto be fixed to a second side inferior vertebra of the spine at aninferior position relative to the transverse coupler, the third rodanchor coupled to the second rod such that the second rod is securedagainst substantial lateral translation relative to the third rod anchorwhile allowing the second rod to change alignment relative to the thirdrod anchor; and a fourth rod anchor adapted to be fixed to a second sidesuperior vertebra of the spine at a superior position relative to thetransverse coupler, the fourth rod anchor coupled to the second rod suchthat the second rod is secured against substantial lateral translationrelative to the fourth rod anchor while allowing the second rod changealignment relative to the fourth rod anchor.

Some aspects relate to a spinal correction system for correcting aspinal deformity of a patient's spinal column, the spinal deformitydefining a deformity section and including an upper deformity level anda lower deformity level, the patient's spinal column including aplurality of vertebrae, the spinal correction system comprising: a firstrod adapted to extend longitudinally along a first side of the spine ofthe patient, the first rod having a length such that the first rodextends from the upper level of the spinal deformity to the lower levelof the spinal deformity; and a plurality of rod anchors, wherein foreach rod anchor of the plurality of rod anchors, the rod anchor includesa pivot point and is: secured to a vertebra of the patient's spine thatis different from any vertebra to which any other rod anchor of theplurality of rod anchors is secured; and coupled to the first rod suchthat the first rod is secured against substantial lateral translationrelative to the pivot point of the rod anchor while allowing the firstrod to change alignment relative to the pivot points of each of theother rod anchors of the plurality of rod anchors.

Some aspects relate to a spinal correction system comprising: a firstrod configured to extend along a first side of a spine; a first rodanchor configured to be secured to a vertebra of the spine and tolaterally constrain the first rod while allowing the first rod to slideaxially and to change in pitch, yaw, and roll about a first pivot point;a second rod anchor configured to be secured to a vertebra of the spineand to laterally constrain the first rod while allowing the first rod toslide axially and to change in pitch, yaw, and roll about a second pivotpoint; a second rod configured to extend along a second side of thespine; a third rod anchor configured to be secured to a vertebra of thespine and to laterally constrain the second rod while allowing thesecond rod to slide axially and to change in pitch, yaw, and roll abouta third pivot point; a fourth rod anchor configured to be secured to avertebra of the spine and to laterally constrain the second rod whileallowing the second rod to slide axially and to change in pitch, yaw,and roll about a fourth pivot point; and a transverse coupler extendinglaterally between the first and second rods, the transverse couplerlaterally constraining the first and second rods and preventing thefirst and second rods from changing in pitch, yaw, and roll relative tothe transverse coupler.

Some aspects relate to a spinal correction system comprising: a rodconfigured to extend along a first side of a spine; a rod anchorconfigured to be secured to a first vertebra of the spine and tolaterally constrain the first rod while allowing the first rod to slideaxially and to change in pitch, yaw, and roll about a first pivot point;and a second rod anchor configured to be secured to a second vertebra ofthe spine and to laterally constrain the first rod and prevent the firstrod from changing in at least pitch, yaw, and roll relative to thesecond rod anchor.

Some aspects relate to a method of correcting a spinal deformity of apatient's spinal column, the method comprising: securing a first rodanchor to a first vertebra of the patient's spine; securing a second rodanchor to a second vertebra of the patient's spine; coupling a first rodto the first rod anchor and the second rod anchor such that: the firstrod is laterally constrained relative to the first rod anchor whilebeing free to slide axially and to change in at least pitch, yaw, androll relative to the first rod anchor; and the first rod is laterallyconstrained relative to the second rod anchor and is prevented fromchanging in at least pitch, yaw, and roll relative to the second rodanchor; securing a third rod anchor to a third vertebra of the patient'sspine; securing a fourth rod anchor to a fourth vertebra of thepatient's spine; and coupling a second rod to the third rod anchor andthe fourth rod anchor such that: the second rod is laterally constrainedrelative to the third rod anchor while being free to slide axially andto change in at least pitch, yaw, and roll relative to the third rodanchor; the second rod is laterally constrained relative to the fourthrod anchor and is prevented from changing in at least pitch, yaw, androll relative to the fourth rod anchor.

This summary is not meant to be limiting in nature. While multipleembodiments are disclosed, still other embodiments will become apparentto those skilled in the art from the following detailed description,which shows and describes various illustrative embodiments. Accordingly,the drawings and detailed description are to be regarded as illustrativein nature and not restrictive.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is an isometric view of an implantable spinal correction andfusion system, according to some embodiments.

FIG. 2 is a cross-sectional view of a spinal rod of the system of FIG.1, according to some embodiments.

FIG. 3 is a cross-sectional view of a stabilizing anchor of the systemof FIG. 1, according to some embodiments.

FIG. 4 is an isometric view of the stabilizing anchor of FIG. 3 with aninsertion sleeve in a retention orientation, according to someembodiments.

FIG. 5 is a plan view of the stabilizing anchor of FIG. 3 with theinsertion sleeve in the retention orientation, according to someembodiments.

FIG. 6 is an isometric view of the stabilizing anchor of FIG. 3 with theinsertion sleeve in an insertion orientation, according to someembodiments.

FIG. 7 is a plan view of the stabilizing anchor of FIG. 3, with theinsertion sleeve in the insertion orientation, according to someembodiments.

FIG. 8 is a front view of the stabilizing anchor of FIG. 3, with theinsertion sleeve in the insertion orientation, according to someembodiments.

FIGS. 9A and 9B show features of another anchor of the system of FIG. 1,according to some embodiments.

FIG. 10 is an isometric view of another stabilizing anchor of the systemof FIG. 1, according to some embodiments.

FIG. 11 is an isometric view of an anchor of the system of FIG. 1,according to some embodiments.

FIG. 12 is an isometric view of a transverse anchor of the system ofFIG. 1, according to some embodiments.

FIG. 13 is an isometric view of an actuation assembly of the system ofFIG. 1, according to some embodiments.

FIG. 14 is a cross-section view of a portion of the actuation assemblyof FIG. 12, according to some embodiments.

FIG. 15 is a bottom view of the actuation assembly of FIG. 12 with aportion of a clamshell housing removed, according to some embodiments.

FIG. 16 is a bottom view of the actuation assembly of FIG. 12, accordingto some embodiments.

FIG. 17 is a cross-sectional view of a connector head and tether of theactuation assembly of FIG. 13, according to some embodiments.

FIG. 18 is a cross-sectional view of the actuation assembly of FIG. 13,showing the connector head and tether in an extended state and aretracted state, according to some embodiments.

FIG. 19 is an isometric view of the system of FIG. 1 during a correctionprocedure, according to some embodiments.

FIGS. 20 and 21 are isometric views of the system of FIG. 1 before andafter assembly of a second rod into the system, according to someembodiments.

FIGS. 22 to 24 are isometric views of the system of FIG. 1 showing aprocess of separating and removing portions of the first rod andstabilizing anchors, according to some embodiments.

FIG. 25 is an isometric view of a system of another configuration,according to some embodiments.

FIG. 26 is an isometric view of another anchor of an implantable spinalcorrection and fusion system, according to some embodiments.

FIG. 27 is an isometric view of another anchor of an implantable spinalcorrection and fusion system, according to some embodiments.

FIG. 28 shows another configuration for an implantable spinal correctionand fusion system, according to some embodiments.

FIG. 29 shows another configuration for an implantable spinal correctionand fusion system, according to some embodiments.

FIG. 30 shows another configuration for an implantable spinal correctionand fusion system, according to some embodiments.

FIG. 31 is a schematic illustration of an implantable spinal correctionand fusion system, according to some embodiments.

FIG. 32 is an isometric view of a transverse coupler of the system ofFIG. 31, according to some embodiments.

FIG. 33 is an isometric view of the transverse coupler of FIG. 32,according to some embodiments.

FIG. 34 is an exploded view of the transverse coupler of FIG. 32,according to some embodiments.

FIG. 35 is a perspective view of a rider of the transverse coupler ofFIG. 32, according to some embodiments.

FIG. 36 is an exploded view of the rider of FIG. 35, according to someembodiments.

FIG. 37 is a top view of the rider of FIG. 35, according to someembodiments.

FIG. 38 is a side view of the rider of FIG. 35, according to someembodiments.

FIG. 39 is a side view of an adjustment arm of the transverse coupler ofFIG. 32, according to some embodiments.

FIG. 40 is a top view of the adjustment arm of FIG. 39, according tosome embodiments.

FIG. 41 is a bottom view of the adjustment arm of FIG. 39, according tosome embodiments.

FIG. 42 is a rear view of the adjustment arm of FIG. 39, according tosome embodiments.

FIGS. 43-46 are side and rear views of a force directing member of thetransverse coupler of FIG. 32 and the adjustment arm of FIG. 39 atvarious angulations, according to some embodiments.

FIGS. 47-49 show the transverse coupler of FIG. 32 at various stages ofrealignment, according to some embodiments.

FIG. 50 is an isometric view of an alternative embodiment of atransverse coupler of the system of FIG. 31, according to someembodiments.

FIGS. 51-53 show top, side, and a rear views, respectively, of thetransverse coupler of FIG. 50, according to some embodiments.

FIG. 54 is an isometric view of an alternative embodiment of atransverse coupler of the system of FIG. 31, according to someembodiments.

FIG. 55 is an isometric view of an alternative embodiment of atransverse coupler of the system of FIG. 31, according to someembodiments.

FIG. 56 is a perspective view of the transverse coupler of FIG. 55 withsome features not shown to facilitate understanding, according to someembodiments.

FIGS. 57-59 show the transverse coupler of FIG. 55 at various stages ofrealignment, according to some embodiments.

FIG. 60 is a schematic illustration of an implantable spinal correctionsystem, according to some embodiments.

FIG. 61 is a schematic illustration of an implantable spinal correctionsystem, according to some embodiments.

FIG. 62 is a schematic illustration of an implantable spinal correctionsystem, according to some embodiments.

FIG. 63 is a schematic illustration of an isometric view of astabilizing anchor system, according to some embodiments.

FIG. 64 is an isometric perspective view of a stabilizing member of FIG.63, according to some embodiments.

Various embodiments have been shown by way of example in the drawingsand are described in detail below. As stated above, the intention,however, is not to limit the invention by providing such examples.

DETAILED DESCRIPTION

Some embodiments relate to a spinal correction and/or fusion system forimplantation into a patient, as well as associated methods and devices.In general terms, the system provides for lateral translationalcorrective force(s) and/or derotational corrective force(s) on a spinalcolumn. In some embodiments, the system includes instrumentation forfacilitating vertebral fusion at a selected region of the spine; thatis, fusing one or more vertebra of a spine to one or more other vertebraof the spine. In some other embodiments, the system provides for lateraltranslational corrective force(s) and/or derotational correctiveforce(s) on a spinal column without vertebral fusion; that is, withoutfusing any vertebra of a spine to any other vertebra of the spine. Somefeatures of the system include implementation of a first, relativelylonger rod for initial correction, and a second, shorter rod forsecondary spinal stabilization. In some embodiments, the spine retainsfreedom of motion (in one or more degrees of freedom) above (superiorto) and below (inferior to) the spinal segment corresponding to theshorter rod, with the first, relatively longer rod remaining implanted.In various embodiments, if desired, the secondary stabilization rod canbe fastened such that the spinal segment corresponding to the shorterrod maintains freedom of motion (in one or more degrees of freedom)while still providing sufficient support and stabilization. In yet someother embodiments, if desired, the secondary stabilization rod can befastened to promote a fusion process at one or more designated spinalsegments, and thereby prohibit any freedom of motion at any of the oneor more designated spinal segments. In yet some other embodiments, thesystem provides means for maintaining a correction to facilitate spinalremodeling in the absence of substantial vertebral fusion (e.g., withoutpermanent vertebral fusion or without any vertebral fusion). In someembodiments the secondary stabilization rod extends along the samevertebral levels as the first, relatively longer rod (e.g., the secondrod is substantially the same length as the first rod).

In some embodiments, the first, relatively longer rod is trimmed and/orremoved following correction, remodeling and/or fusion of the spinalsegment corresponding to the second, shorter rod. A variety ofadditional features and advantages of a spinal correction systems arecontemplated and provided by the instant disclosure. As used herein, thephrase “as shown” is indicative of a feature or features shown in theaccompanying drawings, although as noted it should be understood thatadditional or alternative features to those shown are contemplated.

FIG. 1 shows a spinal correction and fusion system 10, the system 10including a first rod 12; a second rod 14; a plurality of anchors,including a first stabilizing anchor 16, a second stabilizing anchor 18,a first anchor 20, a second anchor 22, a third anchor 24, a fourthanchor 26; a first transverse anchor 28; a second transverse anchor 30;a first adjustment assembly 32; a second adjustment assembly 34; and aplurality of fasteners 36, such as bone screws, for securing componentsof the system 10 to a spine, or spinal column 40 having a first side 40Aand a second side 40B. The system 10 is optionally used to bring thespine 40 to a more natural curvature (e.g., using a single adjustment).In other embodiments, an abnormal curvature in the spinal column 40 hasbeen adjusted to a more natural curvature using other hardware, prior toor in conjunction with securing portions of the system 10 to the spinalcolumn 40. In some embodiments, the system 10 is adapted to initiallyprovide means for leveraged correction, with translation and/orderotation of the spine. If desired, the system 10 is adapted to providemeans for selective fusion of the spine following correction. In otherembodiments, the system 10 provides means for maintaining a correctionto facilitate spine remodeling without vertebral fusion, or withoutpermanent vertebral fusion.

Although the system 10 is shown with a select number of components, suchas two stabilizing anchors 16, 18 two transverse anchors 28, 30, and twoadjustment assemblies 32, 34, more or fewer are implemented asappropriate. For example, in some embodiments a single transverseanchor, such as the first transverse anchor 28, is secured to one ormore of a plurality of vertebrae 42 at an apex A of a spinaldeformation, with a corresponding adjustment assembly, such as the firstadjustment assembly 32, coupled to the transverse anchor 28. Moreover,although four anchors 20, 22, 24, 26 are shown, in some embodimentsthere are more or less of the anchors. For example, in some embodimentsthe system 10 includes the first rod 12, the second rod 14, a singletransverse anchor, such as the transverse anchor 28 and a single anchor,such as the third anchor 24, with the second rod 14 secured between thetransverse anchor 28 and the third anchor 24. In still otherembodiments, the system 10 does not include any of the anchors 20, 22,24, 26, but instead the second rod 14 is secured between the first andsecond transverse anchors 28, 30 (see, e.g., FIG. 25). A variety ofother configurations are also contemplated.

Various planes and associated directions are referenced in the followingdescription, including a sagittal plane defined by two axes, one drawnbetween a head (superior) and tail (inferior) of the body and one drawnbetween a back (posterior) and front (anterior) of the body; a coronalplane defined by two axes, one drawn between a center (medial) to side(lateral) of the body and one drawn between a head (superior) and tail(inferior) of the body; and a transverse plane defined by two axes, onedrawn between a back and front of the body and one drawing between acenter and side of the body. The terms pitch, roll, and yaw are alsoused, where roll generally refers to angulation, or rotation, in a firstplane through which a longitudinal axis of a body orthogonally passes(e.g., rotation about a longitudinal axis corresponding to the spinalcolumn), pitch refers to angulation, or rotation, in a second planeorthogonal to the first plane, and yaw refers to angulation, orrotation, in a third plane orthogonal to the first and second planes. Insome embodiments, pitch is angulation in the sagittal plane, yaw isangulation in the coronal plane, and roll is angulation in thetransverse plane.

In various embodiments, changes in pitch, yaw, and/or roll occurconcurrently or separately as desired. Additionally, in variousembodiments, while pitch, yaw, and/or roll may occur, the system may beconfigured to permit any combination of pitch, yaw, and/or rollmovement, or may alternatively permit only one of pitch, yaw, or roll,or may alternatively permit each of pitch, yaw, and roll. Accordingly,the various embodiments, discussed herein should not be consideredlimiting. Moreover, as used herein, “lateral translation” is not limitedto translation in the medial-lateral direction unless specified as such.

As shown in FIG. 1, in some embodiments the first rod 12, also describedas an elongate member, is secured to the spinal column 40 at apre-selected offset from a longitudinal axis of the spinal column 40.For example, the first rod 12 is optionally secured at an offset along amedial-lateral axis ML, or right-left axis, and anterior-posterior axisAP, or back-front axis. In some embodiments, the first rod 12 is securedon the left side of the spinal column 40 as shown. As subsequentlydescribed, the offset is optionally selected to cause at least arelative lateral translation (e.g., central or medial movement and/oranterior posterior movement) and/or derotational shift (e.g., about acentral axis of the spine) of selected vertebrae 42 of the spinal column40 such that the spinal column 40 exhibits a more natural position.

The first rod 12 is elongate and cylindrical and includes a superiorportion 50, an intermediate portion 52, and an inferior portion 54.However, it should be appreciated that the cross-section of the rod(including any rod disclosed herein) may take on any suitable shape(including, but not limited to, a triangle, square, oval, rectangle,etc.) and is not therefore limited to a circular cross-section. In someembodiments, the first rod 12 is adapted, or otherwise structured, toextend along the spinal column 40. The first rod 12 is optionallycontoured to complement a desired spinal curvature (e.g., generallyfollowing the curvature of a corrected, or natural spine, as shown inFIG. 21). In some embodiments, the first rod 12 is substantially rigid,defining a substantially round cross-section with a mean diameter ofabout 6 mm and being formed of a suitable biocompatible material, suchas titanium alloy ASTM F136, or cobalt chromium alloy ASTM F1537 or anyother suitable implantable material. If desired, the first rod 12incorporates some flex, or springiness while substantially rigidlyretaining its shape. Though some material examples have been provided,the first rod 12 is optionally formed of a variety of materials,including stainless steel or suitable polymeric materials as well as avariety of cross-sectional shapes.

As shown in FIG. 1, the first rod 12 has a longitudinal axis X—where therod 12 is substantially straight, the longitudinal axis X issubstantially straight and, where the rod 12 is substantially curved orangled, the longitudinal axis X is similarly curved or angled. Thesections 50, 52, 54 of the first rod 12 are optionally continuouslyformed or are formed as separate, connected parts as desired. In stillother embodiments, expandable rod designs are also contemplated.

As shown in FIG. 1, the first stabilizing anchor 16 and the first anchor24 are adapted, or otherwise structured, to be mounted, or fixed to oneor more vertebrae, such as vertebrae 41 and 42 located at or nearinferior and apical regions, respectively, along the spine 40.Additional examples of stabilizing anchors and anchors in accordancewith some embodiments of the system 10 are set forth in U.S. applicationSer. No. 13/301,514, filed on Nov. 21, 2011 and entitled TRANSVERSECONNECTOR FOR SPINAL STABILIZATION SYSTEM, and U.S. application Ser. No.12/411,562, filed on Mar. 26, 2009 and entitled SEMI-CONSTRAINEDANCHORING SYSTEM, the entire contents of which are hereby incorporatedby reference.

FIG. 2 is a cross-sectional view of the first rod 12 in the inferiorportion 54 of the first rod 12. As shown, the cross-sectional shape ofthe first rod 12, including various portions thereof, is not limited tocircular cross-sections. For example, the inferior portion 54 optionallyincludes a plurality of splines 60 for mating with the first stabilizinganchor 16. As shown in FIG. 2, the splines 60 are trapezoidal (e.g.,similarly to the teeth of a gear) with rounded bases, although a varietyof shapes, such as involute shapes, are contemplated.

As shown in FIG. 1, the second rod 14 is substantially shorter than thefirst rod 12. For example, the second rod 14 is optionally configured(e.g., having a corresponding length and/or longitudinal contour) toextend along an apical region A of the spine 40 and/or between a desirednumber of anchors, such as the third and fourth anchors 24, 26. Thesecond rod 14 is optionally formed of similar materials and with similarcross-section(s) to that of the first rod 12, as desired.

FIGS. 3 to 8 show the first stabilizing anchor 16 (also described as arod anchor) of the system 10, according to some embodiments. As shown inFIG. 1, the first stabilizing anchor 16 is adapted, or otherwisestructured, to be mounted, or fixed to one or more of the vertebrae 42,such as a first vertebra 42A (FIG. 1) located at an inferior position,or other position, along the spine 40.

As shown in FIG. 3, the first stabilizing anchor 16 is adapted toreceive, and includes means for receiving, the first rod 12 such thatthe first rod 12 is secured laterally, against lateral translationrelative to the first stabilizing anchor 16. In some embodiments, thefirst rod 12 is substantially prevented from translating in a directionsubstantially perpendicular to the longitudinal axis X at a first pivotpoint P1. In turn, the first rod 12 is able to slide axially, ortranslate axially, along the longitudinal axis X of the first rod 12,relative to the first stabilizing anchor 16 through the first pivotpoint P1. In some embodiments, the rod 12 is also able to change inpitch and/or yaw about the first pivot point P1. In yet otherembodiments, the first stabilizing anchor 16 isadditionally/alternatively adapted, or otherwise structured, to limitrotation, or roll, of the first rod 12 about the longitudinal axis X ofthe first rod 12. In some embodiments, the first stabilizing anchor 16provides means for allowing the rod 12 to angulate without substantiallateral translation relative to the first stabilizing anchor 16 andwithout substantial rotation about the longitudinal axis X.

FIG. 4 is an isometric view of the first stabilizing anchor 16,according to some embodiments. As shown, the first stabilizing anchor 16is optionally formed of biocompatible materials and includes a mountingportion 70 and a housing portion 72. The mounting portion 70 is adaptedto secure the first stabilizing anchor 16 to one or more vertebrae 42,such as the first vertebra 42A and an additional vertebra 42 above(superior to) or below (inferior to) the first vertebra 42A. In otherembodiments, the mounting portion 70 is secured to a single vertebra,such as the first vertebra 42A (e.g., laterally across the firstvertebra 70B at the pedicles, or at a single point—such as a singlepedicle—on the first vertebra 26A. In some embodiments, the mountingportion 70, also described as a plate, is adapted to be secured at twoor more points, for example spanning between two vertebrae 42 (e.g., theL3-L4 vertebrae) or spanning across a portion of a single vertebra 42(e.g., pedicle-to-pedicle on a single vertebra).

In some embodiments, the mounting portion 70 includes a pedestal withfirst and second anchor locations, each of the anchor locations defininga surface suitable for mounting the first stabilizing anchor 16 to oneor more vertebrae 42. The first and second anchor locations eachoptionally include through holes 74 for receiving one of the fasteners36, such as a pedicle screw or similar device to secure the mountingportion 70 to one or more vertebrae 42, such as the first vertebra 42A.

In some embodiments, the housing portion 72 is of a multi-piece design(FIGS. 2 to 9). In some other embodiments, the housing portion 72 isformed from a single piece and includes a passage having a revolute,convex surface (FIGS. 10a and 10b ). In a multi-piece housing design, asshown in FIG. 4, the housing portion 72 of the first stabilizing anchor16 includes a body 80 and a sleeve insert 82. In some embodiments, thesleeve insert 82 is substantially spherical in shape and the body 80forms a substantially spherical mating race for receiving the sleeveinsert 82. The body 80 has a sleeve aperture 84 (FIG. 5) extendingfront-to-back through the body 80, the sleeve aperture 84 defining arevolute, substantially concave articulation surface 86 (FIG. 5). Thesleeve insert 82, in turn, forms a complementary revolute, substantiallyconvex articulation surface 88. As shown in FIG. 3, the body 80 also hasa pin chase 90 (e.g., a cylindrical through hole) that defines aterminal seat 92 having a larger diameter than a remainder of the pinchase 90.

FIG. 5 is a plan view of the first stabilizing anchor 16, showing thesleeve insert 82 as it would be received within the body 80 (thoughnormally hidden from view). As shown, the concave articulation surface86 of the aperture 84 defines opposed apices 89 on each side of thearticulation surface 86. The articulation surfaces 86, 88 are adapted,or otherwise structured, to form a substantially complementary fit withone another, such that the sleeve insert 82 is able to be captured bythe body 80 within the aperture 94 and have relative angular movementwith respect to the body 80. To facilitate assembly of the sleeve insert82 into the body 80, the aperture 84 includes first and second channels94, 96 formed into the articulation surface 86 at the apices 89 suchthat the minimum effective internal diameter D of the aperture 84 isincreased between the channels 94, 96. The channels 94, 96 extend frontto back through the body 80 and are positioned on opposite sides of thebody 80. While two channels are shown, in other embodiments a singlechannel is included. FIG. 8 is a front view of the stabilizing anchor16. As shown in FIGS. 5 and 8, the channels 94, 96 have arcuate profilesand extend into the aperture 84 to the apices 89 on each side of thearticulation surface 86. The profiles of the channels 94, 96 areoptionally complementary in shape to a portion of the profile—thelateral edges, or sides—of the sleeve insert 82 such that the sleeveinsert 82 is able to be received through the channels 94, 96 into theaperture 84 when the sleeve insert 82 is oriented perpendicular, oredgewise relative to the body 80. The body 80 also includes a protrusion98 (FIG. 3) (e.g., a pin) or protrusions (not shown) that extendsinwardly into the aperture 84 from the articulation surface 86.

As shown in FIG. 3, the sleeve insert 82 has a passage 100 defining thepivot point P1 through which the splined, or inferior portion 54 of thefirst rod 12 is able to be slidably received. The sleeve insert 82 alsohas a groove 110 extending parallel to the center line of the sleeveinsert into the convex articulation surface 88. The groove 110 isadapted to receive the protrusion 98 for limiting roll of the sleeveinsert 82 within the body 80. The pivot point P1 is defined in thepassage 100, where upon assembly the first rod 12 passes through thefirst pivot point P1 such that the longitudinal axis of the rod at thefirst pivot point P1 is generally concentric with the center of thepassage 100.

As shown, the passage 100 has a non-circular cross-section (e.g., asplined cross-section corresponding to the inferior portion 54 of thefirst rod 12). Upon mating the non-circular cross-sections of the firstrod 12 and the passage 100, rotation of the first rod 12 relative to thesleeve insert 82 is substantially inhibited or prevented. In someembodiments, the passage 100 defines a plurality (e.g., six) of inwardsplines 112 and a plurality of recessed pockets 114 (e.g., six) betweenthe splines 112. The splines 112 are optionally trapezoidal (e.g., likethe teeth of a gear) in shape overall. A variety of shapes arecontemplated for the splines 112, including involute shapes, forexample. The pockets 114 optionally include corner recesses 116 that arerounded in shape (e.g., to help prevent binding between the passage 100and the first rod 112 during sliding of the first rod 112 in the passage100). In some embodiments, the splines 60, 112 are designed to helpmaximize efficiency of torque transfer between the first rod 12 and thesleeve insert 82 while reducing contact pressure angle(s) between thecomponents.

The protrusion 98 is optionally a pin with a head 120, a neck 122, and abody 124, the neck 122 being located between the head 120 and the body124. The head 120, the neck 122, and the body 124 are optionallysubstantially cylindrical with the head 120 having a greater diameterthan the body 124 and the body 124 having a greater diameter than theneck 122. The protrusion 98 is received in the pin chase 90 with thehead 120 received in the seat 92 such that the head projects into theaperture 84. In some embodiments the protrusion 98 is press fit into thepin chase 90 and/or welded, adhered, or otherwise secured within the pinchase 90. In other embodiments the protrusion is temporary and isremovable, providing temporary prevention of roll of the sleeve insert82 within the body 80 so that the first stabilizing anchor 16 is able tobe adjusted so that the rod 12 is free to rotate.

FIGS. 6, 7, and 8 show the sleeve insert 82 being assembled into thebody 80 by positioning the sleeve insert 82 perpendicular, or edgewise,relative to the aperture 84 (FIG. 5) and sliding the sleeve insert 82into the channels 94, 96. In other embodiments, the sleeve insert 82 isable to be inserted at another angle (45 degrees, for example). In thisposition, the diametric plane of the sleeve insert 82 is generallyparallel to the centerline Z of the aperture 84. In alternate terms, thecenterline W of the sleeve insert 82 is generally parallel to thediametric plane of the aperture 84. Once received in the aperture 84 viathe channels 94, 96, the sleeve insert 82 is rotated such that theprotrusion 98 (FIG. 3) is received in the groove 110 (e.g., as shown inFIGS. 3, 4, and 5). With the protrusion 98 slidably received in thegroove 110, the pitch and yaw of the first rod 12 are still able tochange while roll is substantially limited. The first rod 12 alsoremains free to slide axially within the sleeve insert 82, according tosome embodiments.

As relative rotation between the sleeve insert 82 and the body 80 isalso substantially inhibited, relative rotation between the first rod 12and the first stabilizing anchor 16 is substantially inhibited orlimited, allowing the first rod 12 to be maintained at a pre-selectedrotational position relative to the first stabilizing anchor 16. It alsoshould be understood that other cross-sectional shapes for each of thepassage 100 (FIG. 3) and first rod 12 can be selected to allow somedegree of rotation about the longitudinal axis X within a predefinedrange.

As discussed above, in some embodiments, the housing portion 72 isformed from a single piece. For example, as shown in FIGS. 9a and 9b ,the housing 72 includes a body 80. According to some embodiments, thebody 80 is generally ring shaped and forms a passage 81 having arevolute, convex surface 83. Specifically, as shown in FIG. 9b , convexsurface 83 includes an upper curve 85 and a lower curve 87. The body 80is adapted to allow the rod 12 to pass through the passage 81 at thefirst pivot point P1, where the passage 81 defines a minimum effectivediameter (e.g., providing appropriate clearance between the rod 12 andbody 80) that allows the rod 12 to slide through passage 81. The passage81 also allows the rod 12 to rotate and angulate about the longitudinalaxis X at the first pivot point P1 while minimizing lateral translationor inhibiting substantial lateral translation. In at least this manner,the rod 12 is able to rotate and angulate about the longitudinal axis Xat the first pivot point while lateral translation of the rod 12 withrespect to the body 80 is substantially limited in all planes. Inalternate terms, the rod 12 is able to slide within the passage 81 andchange in yaw, pitch, and roll at the first pivot point P1, while beingconstrained from side-to-side movement within the passage 81 at thefirst pivot point P1.

In some embodiments, the second stabilizing anchor 18 is substantiallysimilar to the first stabilizing anchor 16, including any desiredcombination of previously-described features. As shown in FIG. 10, thesecond stabilizing anchor 18 is substantially similar to the firststabilizing anchor 16, with the exception that the second stabilizinganchor 18 has a smooth bore 130 for receiving the first rod 12. Thesecond stabilizing anchor 18 is adapted to be fixed, and provides meansfor fixation to a second vertebra, such as a second vertebra 42B (FIG.1). The second stabilizing anchor 18 is further adapted to receive, andprovides means for receiving the first rod 12 (FIG. 1) such that thesecond stabilizing anchor 18 limits translational movement of the firstrod 12 except along the longitudinal axis X (i.e., the secondstabilizing anchor 18 allows sliding movement of the first rod 12) andallows the first rod 12 to change in at least pitch and yaw about asecond pivot point P2. Moreover, as shown the second stabilizing anchor18 allows the first rod 12 to change in roll about the second pivotpoint P2.

The first anchor 20 is shown in greater detail in FIG. 11, according tosome embodiments. The first, second, third, and fourth anchors 20, 22,24, 26 (FIG. 1) are optionally substantially similar, and thus variousfeatures of the anchors are described in association with the firstanchor 20, where when referenced, features of the first anchor 20 aredesignated with reference numbers and similar features of the second,third, and fourth anchors 22, 24, 26 are designated with the samereference numbers followed by a “B,” “C,” and “D,” respectively.

As shown, the first anchor 20 includes a mounting portion 140, a headportion 142, and a connection portion 144. The mounting portion 140 hasa top surface 150, a bottom surface 152, and a slot 154 for receivingone of the fasteners 36, such as a pedicle screw or other bone screw.The slot 154, also described as an aperture, is elongate and extendslongitudinally in a first direction R1.

The head portion 142 is substantially U-shaped, including a first prong160 and a second prong 162 defining a pocket 164 for receiving one ofthe first and second rods 12, 14. As shown, the prongs 160, 162 arethreaded for receiving a clamping screw 166 adapted to engage and secureone of the first and second rods 12, 14 immobilized within the pocket164.

The connection portion 144 extends in a second direction R2 that isoffset from the first direct R1. The connection portion 144 extendsbetween the mounting portion 140 and the head portion 142 at an angle ofabout 45 degrees, for example, relative to the first direction R1.

The first and second transverse anchors 28, 30 are optionallysubstantially similar, and thus various features of both the first andsecond transverse anchors are described in association with the firsttransverse anchor 28, where when referenced, features of the firsttransverse anchor 28 are designated with reference numbers and similarfeatures of the second transverse anchor 30 are designated with the samereference numbers followed by a “B.”

The first transverse anchor 28 is shown in greater detail in FIG. 12,according to some embodiments. As shown, the first transverse anchor 28includes a mounting portion 170, a head portion 172, a connectionportion 174, and an arm portion 176. The mounting portion 170 has a topsurface 180, a bottom surface 182, and a slot 184 for receiving one ofthe fasteners 36, such as a pedicle screw. The slot 184 is elongate andextends longitudinally in a first direction R1. In some embodiments, thearm portion 176 generally extends away from the mounting portion 170 forpurpose of coupling to the first rod 12 and the head portion serves tocouple the first transverse anchor 28 to the second rod 14.

The head portion 172 is substantially U-shaped, including a first prong190 and a second prong 192 defining a pocket 194 for receiving thesecond rod 14. As shown, the prongs 190, 192 are threaded for receivinga clamping screw 196 adapted to engage and secure the second rod 14immobilized within the pocket 194.

The connection portion 174 extends in a second direction R2 that isoffset from the first direct R1. The connection portion 174 extendsbetween the mounting portion 170 and the head portion 172 at an angle ofabout 45 degrees, for example, relative to the first direction R1. Inother embodiments, the connection portion 174 extends between themounting portion and head portion 170, 172 at another angle, such asfrom about 30 to about 60 degrees, or at no angle (i.e., the portions170, 172, 174 are generally in-line with one another).

The arm portion 176 includes a neck section 200 that is substantiallyelongate and cylindrical, a shoulder section 202 that is flared anddefines an abutment face 203, and a terminal section 204 that isthreaded. The arm portion 176 extends longitudinally in the firstdirection R1. The arm portion 176 is adapted to extend across a portionof one of the vertebrae 42 for example, from one side of the spinalcolumn 40 to an opposite side of the spinal column 40. For example, thefirst transverse anchor 28 is secured to one of the vertebrae 42 suchthat the arm portion 176 extends laterally across the vertebra 42.

FIG. 13 shows the first adjustment assembly 32 from an isometric view,FIG. 14 shows the adjustment 32 assembly from a cross-sectional view,FIG. 15 shows the adjustment assembly 32 from a plan view with a portionof the housing removed, and FIG. 16 shows the adjustment assembly 32from a plan view with the housing intact, according to some embodiments.

The first adjustment assembly 32 is adapted to adjust, and providesmeans for adjusting tension and/or a distance between the first rod 12and the first transverse anchor 28. The first and second adjustmentassemblies 32, 34 are optionally substantially similar. Thus, variousfeatures of both the first and second adjustment assemblies 32, 34 aredescribed in association with the first adjustment assembly 32, wherefeatures of the first adjustment assembly 32 are designated withreference numbers and similar features of the second adjustment assembly34 are designated with the same reference numbers followed by a “B.”

As shown, the first adjustment assembly 32 includes a tensioner 208, thetensioner 208 including a housing 210, a reel 212, a circumferentialgear 214 surrounding the reel 212, a drive gear 216 in contact with thecircumferential gear 214, and an actuation head 218. The firstadjustment assembly 32 also includes an elongate connector 219 adaptedto be wound about the reel 212.

The reel 212, as well as the circumferential gear 214 and drive gear 216are maintained at least partially within the housing 210. In turn, thehousing 210 is adapted to be secured to the first rod 12. For example,the housing 210 optionally forms a central lumen 220 through which therod first 12 is receivable. Upon inserting the first rod 12 through thecentral lumen 220, the housing 210 is adapted to be clamped onto thefirst rod 12.

In some embodiments, the housing 210 defines a first side 223 and asecond side 224 and incorporates a clamshell design (e.g., a firstportion adjustably secured to a second portion) adapted to be tightenedonto the first rod 12 (e.g., using one or more fasteners). Thus, in someembodiments, the first adjustment assembly 32 is substantially fixedwith respect to the first rod 12. Other designs, such as monolithichousing designs and others are contemplated. Moreover, in someembodiments, the first adjustment assembly 32 is movable with respect tothe first rod 12, for example being able to slide and/or rotate aboutthe first rod 12.

The central lumen 220 of the housing 210 defines a longitudinal axis Land forms a pocket 226 for receiving the reel 212 and thecircumferential gear 214 such that the reel 212 and the circumferentialgear 214 are able to rotate within the housing 210. The housing 210 alsodefines a pair of opposed apertures 228 for receiving ends of the drivegear 216 to retain the drive gear 216 while allowing the drive gear 216to rotate. As shown, the housing 210 also defines a top 230 and a bottom232, where the bottom 232 forms a lower opening 234 and a raisedabutment 236 adjacent to the lower opening 234, toward the first side223 of the housing 210.

As shown, the reel 212 includes a helical groove 238 for receiving theelongate connector 219 and a raised anchor block 240 for securing theelongate connector 219 to the reel 212. For example, the anchor block240 optionally includes an aperture for receiving the elongate connector219 and is welded or otherwise fastened in the aperture. The reel 212,as well as the circumferential gear 214, form a lumen 242 for coaxiallyreceiving the first rod 12. In some embodiments, by receiving the firstrod 12 through the reel 212 and circumferential gear 214, an overallsize, or profile, of the tensioner 208 is able to be reduced.

As shown, the circumferential gear 214 is connected to, and coaxiallyaligned with the reel 212. The circumferential gear 214 is engaged withthe drive gear 216 such that rotation of the drive gear 216 causes thecircumferential gear 214, and thus, the reel 212, to turn (e.g., in aworm or crossed-spur gear configuration).

The elongate connector 219 includes a flexible tether 250 and aconnector head 252. In some embodiments, the flexible tether 250 issubstantially flexible and able to be pivoted in a multiple directionsand/or be spooled or wound, for example. Suitable flexible materialsinclude wire and stranded cables, monofilament polymer materials,multifilament polymer materials, multifilament carbon or ceramic fibers,and others. In some embodiments, the flexible tether 250 is formed ofcobalt chromium alloy or titanium alloy wire or cable, although avariety of materials are contemplated. The flexible tether 250 includesa terminal cap 256 (FIG. 17) adapted to be secured in the connector head252. The terminal cap 256 has a rounded (e.g., semi-circular) head andis optionally swaged onto the flexible tether 250. In other embodiments,rather than a swage a loop or other feature is implemented to connect tothe connector head 252.

FIG. 17 is a cross-sectional view of the connector head 252, accordingto some embodiments. As shown, the connector head 252 defines aninternal bore 260 and forms a collar 262, a raised shoulder 264, and aneck 266. The internal bore 260 has a rounded seat 270 (e.g., asubstantially concave seat). The connector head 252 also has a first end272 and a second end 274, the second end 274 having a rounded innerprofile 276 (like the horn of a trumpet). The flexible tether 250 issecured to the connector head 252 by receiving the terminal cap 256 inthe rounded seat 270 in a complementary fit.

The elongate connector 219, also described as a connector or cable, isadapted to be secured to the first transverse anchor 28 and the firstadjustment assembly 32. So secured, the elongate connector 219 definesan effective length between the first transverse anchor 28 and tensioner208 and, and thus the first rod 12 (although, in some embodiments, theelongate connector 219 is secured directly to the rod 12). As described,in some embodiments, the tensioner 208 is adapted to modify, andprovides means for modifying, the effective length of the tether 250 ofthe elongate connector 219 (e.g., by spooling the tether 250 on and offof the reel 212).

The elongate connector 219 is attached or secured to the reel 212 andpasses out of the housing 210 through the lower opening 234 in thehousing 210. Although a lower opening is shown, in other embodiments theopening is in the side or top, for example. Actuation of the drive gear216 via the actuation head 218 turns the circumferential gear 214, whichturns the reel 212, thus winding (or unwinding, depending on thedirection in which the reel 212 is turned) the elongate connector 219about the reel 212. Rotation of the reel 212 in the appropriatedirection draws the tether 250 in toward the tensioner 208 (FIG. 18),pulling the first transverse anchor 28 toward the tensioner 208,according to some methods of correcting a spinal defect.

FIG. 18 shows the first actuation assembly 32 as it would appear in afirst, extended state attached to the uncorrected spinal column 40(e.g., FIG. 19) and as it would appear in a second, retracted state asattached to the corrected spinal column (e.g., FIG. 20), according tosome embodiments. As shown, the connector head 252 engages the raisedabutment 236 and the housing 210 as the tether 250 is drawn into thehousing 210. This engagement and/or the orientation of the lower opening234 (i.e., with the tether 250 exiting the housing 210 through thebottom) helps generate a moment M on the first transverse anchor 28 (notshown in FIG. 18) thereby helping to derotate the third vertebra 42C towhich the first transverse anchor 28 is attached. The ability of thetether 250 to flex and bend at the second end 274 of the connector head252 helps generate a polyaxial connection at the second end 274 andfacilitates generation of the moment M as described.

FIG. 19 shows the assembled system 10. In some embodiments, assembly ofthe system 10 and associated methods of correcting the spine 40 includesecuring the stabilizing anchors 16, 18 to inferior and superiorportions of the spine 40. For example, the first stabilizing anchor 16is optionally secured to the spine 40 by driving one of the plurality offasteners 36 through each of the through holes 74 and into one or moreof the vertebrae 42. For example, as shown in FIG. 1, the firststabilizing anchor 16 is secured with one of the fasteners 36 driveninto a pedicle of the first vertebra 42A and another of the fasteners 26driven into a pedicle of another vertebra that is adjacent to the firstvertebra 42A. The second stabilizing anchor 18 is similarly secured tothe second vertebra 42B and a vertebra adjacent the second vertebra 42B.As shown, each of the first and second stabilizing anchors is secured onthe first side 40A of the spine.

The first and second actuation assemblies 32, 34 are slid onto orotherwise coupled to the first rod 12 and then secured (e.g., clamped)at a desired location along the rod 12. The first rod 12 is received inthe first and second stabilizing anchors 16, 18, with the splined, orinferior portion 54 of the first rod 12 slidably received in the sleeveinsert 82 of the first stabilizing anchor 16 and the superior portion 50of the rod 12 slidably received in the second stabilizing anchor 18.Thus, in some embodiments the first rod 12 extends along the first side40A of the spine 40 and is secured against lateral movement relative toa portion of the spine 40.

In some embodiments, the first rod 12 is attached by the stabilizinganchors 16, 18 to pedicles and/or transverse processes on the first side40A of the spinal column 40 and is able to slide axially relative to thefirst and/or second stabilizing anchors 16, 18. In other embodiments,the rod 12 is attached by the stabilizing anchors 16, 18 to the secondside 40B of the spinal column 40, on different sides of the spinalcolumn 40 (e.g., the first stabilizing anchor 16 on the left side andthe second stabilizing anchor 18 on the right side), or along themid-line of the spinal column 40. In other embodiments, the first rod 12is adjustable length to compensate for changes in length of the spinalcolumn 40.

By limiting rotation, or roll, of the first rod 12 relative to the firststabilizing anchor 16, the bend in the first rod 12 is oriented andmaintained in a desired rotational position. Maintaining the rotationalorientation at one end (i.e., at the first stabilizing anchor 16) isuseful, for example, to help ensure that the bend or shape of the rod 12consistently follows or otherwise appropriately tracks a desiredcurvature of a spinal column 40. Freedom of rotation at the other end ofthe first rod 12 (i.e., at the second stabilizing anchor 18), however,still permits the spinal column 40 to have more natural movement whilethe corrective forces are being applied.

Though not shown, the system 10 optionally includes one or more stopfeatures for limiting axial sliding, or translation of the first rod 12relative to one of the stabilizing anchors to a desired range.Generally, sliding of the first rod 12 in a particular axial directionis substantially limited, or arrested, when a stop feature engages, orabuts an adjacent stabilizing anchor 16, though other stop mechanismsare contemplated.

The first and second transverse anchors 28, 30 are secured to one ormore of the vertebrae 42, such as a third vertebra 42C in an apicalregion A of the spine 40 and a fourth vertebra 42D in an apical region Aof the spine 40. The first transverse anchor 28 is secured to the thirdvertebra 42C by driving one of the fasteners 36 through the slot 184 inthe mounting portion 170 of the first transverse anchor 28. For example,the first transverse anchor 28 is optionally secured into a pedicleand/or transverse processes of the third vertebra 42C on the second side40B of the spine 40. The second transverse anchor 30 is optionallysimilarly secured on the second side of the spine 42B to a pedicle ofthe fourth vertebra 42D. As shown, the arm portions 176, 176B (FIG. 12)of the first and second transverse anchors 28, 30 extend from the secondside 40B of the spine 40 to the first side 40A of the spine 40.

The first and second actuation assemblies 32, 34 are secured to thefirst and second transverse anchors 28, 30 by attaching (e.g., screwing)the connector heads 252, 252B of the elongate connectors 219, 219B tothe threaded terminal sections of the transverse anchors 28, 30. Somemethods include adjusting a curvature of the spine 40 to a desiredcurvature using the actuation assemblies 32, 34. For example, thetensioners 208, 208B of the first and second actuation assemblies 32, 34are actuated (independently or simultaneously) in order to draw theelongate connectors 219, 219B into the respective tensioners 208, 208B,thereby drawing the third and fourth vertebrae 42C, 42D and surroundingportions of the spine 40 toward the first rod 12 and to a more desirablespinal curvature.

As shown in FIG. 20, the first and third anchors 20, 24 are secured to afifth vertebra 42E and the second and fourth anchors 22, 26 are securedto a sixth vertebrae 42E, 42F of the spine 40, thought each of theconnectors is optionally secured to a different vertebra. The firstanchor 20 is secured along the spine 40 at a location between the firststabilizing anchor 16 and the first actuation assembly 32 and the secondstabilizing anchor 18 is secured at a location between the secondstabilizing anchor 18 and the second actuation assembly 34. The firstand second anchors 20, 22 are secured on the first side 40A of the spine40 whereas the third and fourth anchors 24, 26 are secured on the secondside 40B of the spine 40 opposite the first and second anchors 20, 22,for example. The first anchor 20 is secured to a pedicle of the fifthvertebra 42E by driving one of the fasteners 36 into the pedicle throughthe slot 154 in the mounting portion 140 of the first anchor 20. Thesecond, third, and fourth anchors 22, 24, 26 are optionally similarlysecured to the spine 40.

If desired, the first rod 12 is received in the first and second anchors20, 22 (e.g., prior to securing the first and second anchors 20, 22 tothe spine 40) and the first rod 12 is secured in the pocket 164 of thefirst anchor 20 using the clamping screw 166 (FIG. 11). The first rod 12is similarly secured in the second anchor 22, thereby immobilizing thefirst rod 12 between the first and second anchors 20, 22.

As shown in FIG. 21, the second rod 14 is received in the transverseanchors 28, 30, and optionally in the third and fourth anchors 24, 26(e.g., prior to securing the third and fourth anchors 24, 26 to thespine 40) in order to provide secondary stabilization to thecorresponding region of the spine 40. For example, the second rod 12 issecured in the pocket of the third anchor 24 using the clamping screwand in the pocket 194 of the first transverse anchor 28 using theclamping screw 196 (FIG. 12). The second rod 14 is similarly secured inthe second transverse anchor 30 and the fourth anchor 26, therebyimmobilizing the second rod 14 between the third and fourth anchors 24,26. As shown, the first and second rods 12, 14 are on opposite sides ofthe spine 40, immobilizing a desired region of the spine 40 (e.g., aspart of a spinal fusion process), such as an apical region A of thespine 40. As appropriate, bone cement, fillers, or other materials areoptionally employed with one or more vertebrae 42 to facilitateintervertebral fusion. In other embodiments, the system 10 is configuredto avoid fusion of the spine 40. For example, the first and/or secondrods 12, 14 are optionally substantially flexible such that the system10 allows sufficient movement of the spine 40 to help avoidintervertebral fusion while still providing structural support duringgrowth and remodeling of the spine 40.

As shown in FIG. 22, if desired (e.g., once the spine 40 is stabilized),the first rod 12 is clipped, cut, broken, or otherwise portioned betweenthe first anchor 20 and the first stabilizing anchor 16 and between thesecond anchor 22 and the second stabilizing anchor 18. As shown in FIG.23, the superior and inferior portions of the first rod 12 areoptionally removed from the first and second stabilizing anchors 16, 18and the first and second stabilizing anchors 16, 18 are removed from thespine 40. As another alternative, the first rod 12 is not portioned andis left free to move in the stabilizing anchors 16, 18, for example.Moreover, if desired, the entire system 10 is optionally removed after adesired amount of fusion of the spine has been achieved and/or aftersufficient growth and remodeling of the spinal curvature has beenachieved. For example, once a diseased area of the spine hassufficiently healed (e.g., after being fused and stabilized) thestability provided by the system 10 may no longer be required.

Thus, according to various embodiments, the spinal column 40 (and thus,the person) is able to twist, bend side-to-side, and bendforward-and-backward in a more natural manner while corrective forcesare being applied to the spinal column 40 and/or to achieve a desiredcorrection of the spine 40. In some embodiments, the effective lengthsof the actuation assemblies 34, 36, and specifically the elongateconnectors 219, 219B are adjusted (e.g., periodically or all at onetime), bringing the spinal column into natural alignment, while thesystem 10 facilitates a more natural movement of the spinal column 40(e.g., twisting and bending forward-and-backward and side-to-side) dueto the freedom of movement afforded by the system 10. During a secondaryfusion procedure, the second rod 14 is secured to the corrected spine 40opposite first rod 12 to rigidly secure a region of the spine for fusionas shown in FIG. 24. If desired, this includes immobilizing an apicalregion A of the spine 40 and leaving a superior region of the spine 40adjacent to the apical region A and an inferior region of the spine 40adjacent to the apical region A free to move in at least one degree offreedom. The at least one degree of freedom optionally includeselongation, or growth, compression, twisting, and/or flexing. In someembodiments, the freedom of movement of the first rod 12 provided by thestabilizing anchors 16, 18 helps facilitate this motion. In otherembodiments, removal of one or more portions of the system 10 (e.g.,clipping and removing portions of the rod 12) facilitates this motion.

In some embodiments, by linking the convex and concave sides of thespine 40 together, stress on the spine 40 is distributed at theanchor-vertebral interfaces as well as stiffening the apical region A ofthe spine, helping to stabilize the deformity. Thus, in addition to theconnection between the apical region A and the first rod 12, the lateralconnection between the rods 12, 14 optionally helps resist vertebralrotation and lateral translation).

As previously indicated, in some embodiments, the spine 40 is optionallycorrected, or tensioned toward the first rod 12 prior to securing thesecond rod 14 to the spine 40. In other embodiments, the correctivemethod includes securing the second rod 14 to the spine 40 (e.g., topartially or fully correct spinal curvature the apical region A) andthen tensioning the second rod 14 toward the first rod 12 in order tocorrect the spine 40 or portions thereof (e.g., a curvature of the spine40 superior and/or inferior to the apical region A).

As previously indicated, the system 10 may include greater or fewercomponents according to various embodiments. FIG. 25 is an example ofthe system 10, which includes correction and secondary stabilizationfeatures, the system 10 including fewer components. With reference toFIG. 19, the system 10 is optionally used to correct a spinal deformity(including a total or partial correction) and then the second rod 14 isreceived in, and secured in, the pockets 194, 194B of the first andsecond transverse anchors 28, 30. The secondary stabilization providedby the second rod 14 is optionally used to facilitate fusion of thespine 40, including use of growth promoters or other materials forencouraging intervertebral fusion.

FIG. 26 shows another stabilizing anchor 16A (also described as a rodanchor) of the system 10, according to some embodiments. The firststabilizing anchor 16A is adapted, or otherwise structured, to bemounted, or fixed to one or more of the vertebrae 42, such as a firstvertebra 42A (FIG. 1) located at an inferior position, or otherposition, along the spine 40.

As shown, the first stabilizing anchor 16A is substantially similar tothe first stabilizing anchor 16. The first stabilizing anchor 16Aincludes a mounting portion 70A and a housing portion 72A. The mountingportion 70A optionally includes through holes 74A for receiving one ofthe fasteners 36, such as a pedicle screw or similar device to securethe mounting portion 70A to one or more vertebrae 42, such as the firstvertebra 42A.

The housing portion 72A of the first stabilizing anchor 16A includes abody 80A and a sleeve insert 82A. The body 80A is substantially similarto the body 80 of the first stabilizing anchor 16 with an optionaldifference being that the body 80A is split by a gap 298A dividing thebody 80A into a lower portion 300A and an upper portion 302A that can beclamped together with adjustment member 304A (e.g., a bolt) securedacross the gap 298A. The sleeve insert 82A, in turn, is substantiallysimilar to the sleeve insert 82 with the addition of a gap 306A thatfacilitates clamping of the sleeve insert 82A onto the rod 12. Forexample, upon sufficiently tightening the adjustment member 304A, thesleeve insert 82A is clamped onto rod 12 to arrest sliding and rollingmotion of the rod 12 through the sleeve insert 82A. Additionally, theclamping action of the body 80A on the sleeve 82A arrests changes inpitch and yaw. In different terms, the rod 12 is able to be selectivelylocked relative to the stabilizing anchor 16A.

FIG. 27 shows another stabilizing anchor 16B (also described as a rodanchor) of the system 10, according to some embodiments. The firststabilizing anchor 16B is adapted, or otherwise structured, to bemounted, or fixed to one or more of the vertebrae 42, such as a firstvertebra 42A (FIG. 1) located at an inferior position, or otherposition, along the spine 40.

As shown, the first stabilizing anchor 16B is substantially similar tothe first stabilizing anchors 16, 16A and includes a clamping mechanismsimilar to first stabilizing anchor 16A. The first stabilizing anchor16B includes a mounting portion 70B and a housing portion 72B. Themounting portion 70B differs from the mounting portion 70A of the firststabilizing anchor 16A in that the mounting 70B portion includes asingle through hole 74A for receiving one of the fasteners 36, such as apedicle screw or similar device to secure the mounting portion 70B toone or more vertebrae 42, such as the first vertebra 42A. In someembodiments, the first stabilizing anchor 16B is adapted to be securedto a single vertebra, as compared to being secured across multiplevertebrae.

FIG. 28 shows the system 10 employing the first stabilizing anchor 16Aand a second stabilizing anchor 18A that is substantially the same asthe first stabilizing anchor 16A, according to some embodiments. Asshown in FIG. 28, the rod 12 of the system 10 is able to slide andchange in pitch, yaw, and roll at both of the anchors 16A, 18A and isalso able to be selectively locked against sliding, pitch, yaw, and rollat each of the first and second stabilizing anchors 16A, 18A. Selectivelocking at one or both anchors 16A, 18A is optionally employed for avariety of reasons, including for performing partial or total fusion, tofacilitate a correction, or adjustment process using the tensioners 32,34, or to facilitate assembly of the system 10 prior to a correctionoperation.

FIG. 29 shows the system 10 employing the first and second stabilizinganchors 16A, 18A similarly to FIG. 28, according to some embodiments. Inaddition, the first anchor 20 and the second anchor 22 shown in FIG. 28are replaced by first and second anchors 20B, 22B, which are eachsubstantially the same as the first stabilizing anchor 16B (FIG. 27). Asshown in FIG. 29, the rod 12 of the system 10 is able to slide andchange pitch, yaw and roll at the anchors 16A, 18A, 20B, 22B and is alsoable to be selectively locked against sliding, pitch, yaw, and roll ateach of the anchors 16A, 18A, 20B, 22B as desired. Once again, selectivelocking at any of the anchors 16A, 18A, 20B, 22B is optionally employedfor a variety of reasons, including for performing partial or totalfusion, to facilitate a correction, or adjustment process using thetensioners 32, 34, or to facilitate assembly of the system 10 prior to acorrection operation.

FIG. 30 shows the system 10 employing a plurality of anchors, each ofwhich is substantially similar to the first stabilizing anchor 16B (FIG.27). As shown in FIG. 30, the rod 12 of the system 10 is able to slideand change in pitch, yaw and roll at the anchors 16B, 18B, 20B, 22B. Thefirst anchor 16B optionally employs a chase feature similar to thosepreviously described to limit roll. Alternatively, the first anchor 16Bfreely permits roll of the rod 12. As shown in FIG. 30, the rod 12 has ahigh degree of freedom, while being laterally constrained, as desired.In particular, the rod 12 is also able to be selectively locked againstsliding, pitch, yaw, and roll at each of the anchors 16B, 18B, 20B, 22Bas desired. Once again, selective locking at any of the anchors isoptionally employed for a variety of reasons, including for performingpartial or total fusion, to facilitate a correction, or adjustmentprocess using the tensioners 32, 34, or to facilitate assembly of thesystem 10 prior to a correction operation. From the foregoing, it shouldbe understood that a variety of numbers and configurations of theanchors is contemplated. Though not specifically shown, it should alsobe understood that any of the foregoing anchors are employed with thesecond rod 14 on the second side of the spine.

While the spinal correction system configurations discussed aboveinclude one or more adjustment assemblies for lateral coupling, invarious alternative embodiments discussed in greater detail below, thespinal correction system may additionally/alternatively include one ormore transverse couplers for lateral coupling.

Similar to those embodiments discussed above, the spinal correctionsystem 100 discussed below includes a first rod 12 (as described above),a second rod 14 (as described above), and plurality of stabilizinganchors. However, in some embodiments, the spinal correction system 100additionally/alternatively includes one or more transverse couplers. Forexample, as shown in FIG. 31, in lieu of the above-discussed adjustmentassemblies 32, the spinal correction system 100 includes transversecouplers (such as transverse couplers 320 and 340). While the subsequentembodiments utilize transverse couplers in lieu of the above-discussedadjustment assemblies 32 it should be appreciated that one or more ofthe below discussed transverse couplers 320 may be implemented orotherwise utilized in combination with one or more of theabove-discussed adjustment assemblies 32.

The system 100 is optionally used to bring the spine 40 to a morenatural curvature (e.g., prior to or as a part of a single adjustment ormultiple adjustments). In some embodiments, an abnormal curvature in thespinal column 40 has been adjusted to a more natural curvature usingother instrumentation, prior to or in conjunction with securing portionsof the system 100 to the spinal column 40. In some embodiments, thesystem 100 is adapted to provide means for leveraged correction, withtranslation and derotation of the spine 40. If desired, the system 100is adapted to provide means for selective fusion of the spine 40following correction. In other embodiments, the system 100 providesmeans for maintaining a correction to facilitate spinal remodeling inthe absence of substantial vertebral fusion (e.g., without permanentvertebral fusion or without any vertebral fusion).

Although the system 100 is shown in FIG. 31 with a selected number ofcomponents, such as six stabilizing anchors 16, 18, 20, 22, 23, 25, fouranchors 24, 26, 28, 30, two transverse couplers 320, 340, more or fewercomponents are implemented as appropriate. For example, in someembodiments, the system 100 includes the first rod 12, the second rod14, a single transverse coupler, such as the first transverse coupler320, and a first anchor, such as the first anchor 24, with the first rod12 secured by the first transverse coupler 320 and the second rod 14secured between the first transverse coupler 320 and the first anchor24. A variety of other configurations are also contemplated.

As shown in FIG. 31, the first rod 12 has a longitudinal axis X1—wherethe rod 12 is substantially straight, the longitudinal axis X1 issubstantially straight and, where the rod 12 is substantially curved orangled, the longitudinal axis X1 is similarly curved or angled.

FIGS. 32 to 34 show the first transverse coupler 320 (also described asan anchor or connector) of the system 100, according to someembodiments. As shown in FIG. 32, the first transverse coupler 320 isadapted, or otherwise structured, to be positioned laterally across avertebra, such as the first apical vertebra 42 (FIG. 31) located at ornear the apex of the defective curvature along the spine 40. As shown,the first transverse coupler 320 is designed to extend, either partiallyor fully, from the first side 40A of the spine 40 to the second side 40Bof the spine 40.

FIGS. 32 and 33 provide isometric views of the first transverse coupler320, according to some embodiments. As shown, the first transversecoupler 320 is adapted, or otherwise structured, to receive the firstrod 12, such that the first rod 12 is secured laterally relative to aportion of the first transverse coupler 320. In some embodiments, thefirst rod 12 is substantially prevented from translating in a directiongenerally perpendicular to the longitudinal axis X1 at a first pivotpoint P1 while the rod 12 is able to slide axially, or translateaxially, along the longitudinal axis X1 through the first pivot point P1and also to change in pitch and yaw about the first pivot point P1.

In some embodiments, the first transverse coupler 320 is adapted, orotherwise structured, to substantially limit rotation, or roll, of thefirst rod 12 about the longitudinal axis X1 of the first rod 12.According to some embodiments, the first transverse coupler 320 providesa means for allowing the rod 12 to angulate without substantial lateraltranslation relative to the portion of the first transverse coupler 320and without substantial rotation about the longitudinal axis X1.

In some embodiments, the first transverse coupler 320 provides a meansfor selectively locking the first rod 12 to substantially preventchanges in axial translation, pitch, yaw, and/or roll. The selectivelocking feature is optionally suitable for constraining movement of therod 12 under conditions associated with implantation of the system 100and/or under conditions associated with spinal loading of the system 100following implantation and securement of the system to the spine 40.

The first transverse coupler 320 is optionally adapted secured to ananchor point on the second side of the spine. In some embodiments, thetransverse coupler 320 is secured to an anchor point on the second side40B of the spine 40 where the anchor point is a spinal anchor directlysecured to a vertebral body (not shown). For example, the spinal anchoris optionally a pedicle screw, hook or clamp. In some embodiments, thetransverse coupler 320 is secured to an anchor point on the second side40B of the spine 40 where the anchor point includes a rod couplerconfigured to be secured to a second rod 14 extending longitudinallyalong a second side 40B of a spine 40.

In some embodiments, the first transverse coupler 320 is adapted toreceive the second rod 14 such that the second rod 14 is securedlaterally against lateral translation relative to a portion of the firsttransverse coupler 320. In some embodiments, the second rod 14 issubstantially prevented from translating in a direction substantiallyperpendicular to the longitudinal axis X2 at a second pivot point P2. Inturn, in some embodiments, the second rod 14 is able to slide axially,or translate axially, along a second longitudinal axis X2, relative tothe first transverse coupler 320 through a second pivot point P2. Thesecond rod 14 is optionally able to change in pitch and yaw about thesecond pivot point P2.

The first transverse coupler 320 is optionally adapted, or otherwisestructured, to substantially limit rotation, or roll, of the second rod14 about the second longitudinal axis X2 of the second rod 14. The firsttransverse coupler 320 provides means for allowing the second rod 14 toangulate without substantial lateral translation relative to the portionof the first transverse coupler 320 and without substantial rotationabout the second longitudinal axis X2, according to some embodiments.

In some embodiments, the first transverse coupler 320 provides a meansfor selectively locking the second rod 14 to substantially preventchanges in axial translation, pitch, yaw, and/or roll. The selectivelocking feature is optionally suitable for constraining movement of therod 14 under conditions associated with implantation of the system 100and/or under conditions associated with spinal loading of the system 100following implantation and securement of the system to the spine 40.

The first transverse coupler 320 is optionally formed of suitablebiocompatible metallic materials, such as titanium, titanium alloy ASTMF136, stainless steel, cobalt chromium alloy ASTM F1537, and/or suitablebiocompatible polymeric materials, such as PEEK and/or compositematerials.

FIG. 34 is an exploded view of the first transverse coupler 320. Asshown, the first transverse coupler 320 includes an adjustment assembly60 (also described as an adapter or adjustor) adapted to be secured to afirst rod 12 extending longitudinally along a first side 40A of thespine 40. According to some embodiments, the adjustment assembly 60includes a rider 66, an adjustment retainer 70, and a first rod coupler72 to receive the first rod 12. As shown, the first transverse coupler320 also includes an adjustment arm 62 adapted to be secured to thesecond rod 14 and extends from the first side 40A of the spine 40 to asecond side 40B of the spine 40, as well as a force directing member 64having an elongate body 74 adapted to extend between the adjustmentassembly 60 and the adjustment arm 62.

As subsequently described, in some embodiments, the first rod coupler 72is a multi-piece design (e.g. as shown in FIGS. 32-38). In otherembodiments, the first rod coupler 72 is a single-piece design adapted,or otherwise structured, for receiving the first rod 12 (FIGS. 55-56).

As shown in FIG. 34, the adjustment assembly 60 connects to the forcedirecting member 64 and the first rod 12, which extends along the firstside 40A of the spine 40. As shown in FIG. 31 and FIGS. 43-46, theadjustment assembly 60 and force directing member 64 are optionallyadapted to be positioned on the first side 40A of the spine 40. In someembodiments, the adjustment arm 62 is adapted to span across a portionof the first apical vertebra 42 (e.g., lamina-to-lamina orpedicle-to-pedicle on a single vertebra).

FIGS. 35-38 show features of the adjustment assembly 60. As shown, theadjustment assembly 60 has a first rod coupler 72, a rider 66 (alsodescribed as a slider or adjuster), and an adjustment retainer 70, alsodescribed as a fastener or tightener (see FIGS. 37 and 38).

As shown in FIGS. 34-36, the first rod coupler 72 of the adjustmentassembly 60 includes a body 82 and a sleeve insert 84. In someembodiments, the body 82 defines a sleeve aperture 88 extending througha first side 93 of the body 82 to a second side 94 of the body 82. Thesleeve aperture 88 is configured for receiving the sleeve insert 84,according to some embodiments. In some embodiments, the sleeve aperture88 is adapted to mate with the sleeve insert 84, the sleeve insert 84forming a revolute, substantially concave articulation surface 86. Insome embodiments, the sleeve insert 84 forms a revolute, substantiallyconvex articulation surface 90 that complements the sleeve aperture 88.The body 82 has also optionally has a pin chase 92 (e.g. a cylindricalthrough hole) that extends from the outer surface 96 of the body 82 tothe articulation surface 86.

FIG. 37 is a top plan view of the adjustment assembly 60 showing some ofthe internal features of the body 82. As shown, the concave articulationsurface 86 of the aperture 88 is adapted, or otherwise structured, toform a substantially complementary fit with the sleeve insert 84. Insome embodiments, the sleeve insert 84 is able to be captured by thebody 82 within the aperture 88 and have relative angular movement withrespect to the body 82.

In some embodiments, the sleeve insert 84 has a passage 98 defining apivot point P1 through which a portion of the first rod 12 is able to bereceived. As shown, the pivot point P1 is defined in the passage, where,upon assembly, the first rod 12 passes through the first pivot point P1such that the longitudinal axis X1 of the rod 12 at the first pivotpoint P1 is generally concentric with the center of the passage.

As shown, the sleeve insert 84 has a smooth bore 100 for receiving thefirst rod 12. In some embodiments, the sleeve insert 84 is adapted tohelp allow the first rod 12 to pass through the passage 98 at the firstpivot point P1, where the passage 98 helps allow the rod 12 to angulateabout the longitudinal axis X1 at the first pivot point P1 (shown inFIGS. 32, 33, 36, and 38) while rotation and lateral translation of thefirst rod 12 with respect to the first rod coupler 72 is substantiallylimited in all planes. In alternative terms, the first rod coupler 72 ofthe adjustment assembly 60 is configured to be substantially laterallyconstrained by a first rod 12 when the first rod coupler 72 receives thefirst rod 12. The first rod coupler 72 selectively locks rotation of thefirst rod 12 while helping to allow the first rod 12 to axiallytranslate through the first rod coupler 72 and to pivot in pitch and yawat the first pivot point P1, according to some embodiments.

As shown in FIGS. 34, 36, and 38, in some embodiments, the body 82 alsoincludes a first protrusion 102 (e.g., a pin) or protrusions (not shown)that extend inwardly into the aperture 88 from the articulation surface86. The first protrusion 102 is optionally a pin with a head 104, a neck106, and a body 108, the neck 106 being located between the head 104 andthe body 108 (see FIG. 34). The head 104, the neck 106, and the body 108are optionally substantially cylindrical with the head 104 having agreater diameter than the body 108 and the body 108 having a greaterdiameter than the neck 106. The first protrusion 102 is optionallyreceived in the pin chase 92 such that the head 104 projects into theaperture 88. In some embodiments the first protrusion 102 and/or body108 is press fit into the pin chase 92 and/or welded, adhered, orotherwise secured within the pin chase 92. In some embodiments, thefirst protrusion is temporary and is removable in association with animplantation procedure, providing temporary prevention of roll of thesleeve insert 84 within the body 82 before, during, and/or aftersecuring the system 100 to the spine 40, for example.

As shown, the body of the first rod coupler 72 also includes a lockingportion 120. In some embodiments, the locking portion 120 has an upperportion 122 and a lower portion 124 separated by a gap 126 (FIG. 36). Insome embodiments, the upper portion 122 has a through slot 125 (FIG. 36)that helps allow a locking member 128 (e.g., a male threaded bolt) toslidably pass through the upper portion 122. The lower portion 124optionally has a bore (e.g., a female threaded bore), at least partiallyextending through the lower portion 124. The upper portion 122 and thelower portion 124 can optionally be locked, or clamped, together withthe locking member 128 secured across the gap 126. In some embodiments,the locking portion 120 of the first rod coupler 72 is adapted to lockthe sleeve insert 84 within the body 82 of the first rod coupler 72.

In some embodiments, the locking portion 120 is adapted to lock thefirst rod 12 to the first rod coupler 72. As shown in FIG. 34, thesleeve insert 84 has a gap 132 that facilitates locking of the sleeveinsert 84 onto the first rod 12. For example, in some implementations,upon sufficiently tightening the locking member 128, the sleeve insert84 is locked onto rod 12 to arrest axial translation of the rod 12through the sleeve insert 84. In some implementations, the lockingaction of the body 82 on the sleeve insert 84 arrests changes in pitchand yaw. In different terms, the rod 12 is able to be selectively lockedrelative to the first transverse coupler 320 to substantially preventchanges in axial translation, pitch, yaw, and/or roll as desired.

The first rod coupler 72 defines a rod pivot point P1 and is optionallyconfigured to be transitioned from an unlocked state in which a firstrod 12 received by the first rod coupler 72 is able to axially translateand change in pitch and yaw about the first rod pivot point P1 to alocked state in which the first rod 12 received by the first rod coupler72 is locked against axial translation and changes in pitch and yawabout the rod pivot point. When the first rod coupler 72 receives thefirst rod 12, the first rod coupler 72 is substantially laterallyconstrained by the first rod, according to some embodiments.

As shown in FIGS. 35-38, the rider 66 (also described as slider oradjuster) includes a first surface 110 and a second surface 112connected by a lateral wall 114. In some embodiments, the rider 66 issubstantially oval-shaped and extends from the lower portion 124 of thelocking portion 120. As shown, the first surface 110 of the rider 66faces generally away from the adjustment arm 62. During operation, theadjustment retainer 70 abuts the first surface 110 of the rider 66 andmoves the rider 66 along the force directing member 64, according tosome embodiments. Although the adjustment retainer 70 is shown on therider 66, it should be understood that the adjustment retainer 70 andthe rider 66 are not a single unit, but are separate, relativelymoveable components, according to some embodiments. As shown, the secondsurface 112 of the rider 66 faces generally toward the adjustment arm62. During operation, the second surface 112 of the rider 66 engageswith the adjustment arm 62 when the adjustment assembly 60 is movedalong the force directing member 64 and brought in contact with theadjustment arm 62, according to some embodiments.

As shown in FIG. 36, the rider 66 also includes a slot 116 extendingthrough the rider 66 from the first surface 110 to the second surface112. As shown, the slot 116, also described as an articulation aperture,has an elongate transverse cross-section. In some embodiments, the slot116 is configured to receive the elongate body 74 of the force directingmember 64 such that the elongate body 74 of the force directing member64 is adjustable within the slot 116 in the direction in which the slot116 is elongated. In operation, the rider 66 is optionally moveablealong the force directing member 64 by, for example, moving the rideralong the force directing member. The slot 116 is optionally configuredto help allow the force directing member 64 extend through the rider 66at a substantially orthogonal angle relative to the second surface ofthe rider 66, as well as a variety of additional angles as desired. Forexample, the slot 116 is optionally configured to help allow the forcedirecting member 64 to angulate, or pivot, within the slot 116 such thatthe force directing member extends through a plurality of angles (e.g.,orthogonal and non-orthogonal) relative to the second surface 112 of therider 66. In some embodiments, the slot 116 is configured to allow theforce directing member 64, but not the adjustment retainer 70 to extendthrough the slot 116 of the rider 66. Consequently, the adjustmentretainer 70 abuts the first surface 110 of the rider 66 adjacent theslot 116 and does not extend through the slot 116 of the rider 66,according to some embodiments.

As shown in FIGS. 37 and 38, the adjustment retainer 70 is configured tocouple to the force directing member 64. The adjustment retainer 70 isconfigured to travel along the force directing member 64 in a directionof a central axis defined by the elongate body 74 of the force directingmember 64 as desired. In some embodiments, the adjustment retainer 70 isa threaded cap 130 (e.g., a female threaded nut) configured to mate withand be screwed down the length of the force directing member 64,pressing against the rider 66, and thereby helping to move the rider 66along the force directing member 64 as the adjustment retainer 70 isactuated along the force directing member 64.

FIGS. 32-34 show features of the force directing member 64 (alsodescribed as a connector), according to some embodiments. In someembodiments, the force directing member 64 includes the elongate body 74and extends from a first end 140 and a second end 142. In otherembodiments, the elongate body includes a head portion with a pocketconfigured to receive a rod, for example, a rod-shaped portion of therider and/or adjustment arm (not shown). In some embodiments, the forcedirecting member 64 includes a threaded, elongate body 74 adapted tomate with the threaded cap 130 of the adjustment retainer 70.Alternatively, in some embodiments, the elongate body 74 has teeth,barbs or stepped features along the elongate body 74 adapted to matewith teeth, barbs, or complementary features of the adjustment retainer70. Some examples of the force directing member 64 optionally include,but are not limited to, a threaded screw, a standard bolt, a togglebolt, a female threaded partial tube, a cable tie, a zip tie, a pegfastener or other type of selectively adjustable mechanism.

The first end 140 of the force directing member 64 is optionally adaptedto be received within an aperture 144, also described as an articulationaperture or a socket, of the adjustment arm 62. In some embodiments, thefirst end 140 of the force directing member 64 is adapted to allow theforce directing member 64 to change in pitch, yaw and roll from withinthe aperture 144. As shown in FIG. 32, the first end 140 is generallyspherically shaped and is adapted to fit within the aperture 144. Insome embodiments, the first end 140 of the force directing member 64 isadapted to substantially limit the force directing member 64 fromsubstantially changing in pitch, yaw and roll from within the aperture144. The first end 140 of the force directing member 64 is optionally agenerally polygon-shaped end. For example, a force directing member 64with a square-end, when fit into a complementary polygon-shaped apertureof the adjustment arm 62, is substantially prevented from changing inpitch, yaw, and roll from within the aperture. Alternatively, a forcedirecting member can optionally include a cylinder-end, e.g. a T-shapedfirst end, which when fit into a complementary shaped aperture of theadjustment arm 62, is substantially prevented from changing in pitch,but allows changes in yaw and roll from within the aperture.

The force directing member 64 is adapted to be secured to the adjustmentassembly 60 and the adjustment arm 62 such that the elongate body 74 ofthe force directing member 64 extends between the rider 66 of theadjustment assembly 60 and the adjustment arm 62, according to someembodiments. The first force directing member 64 has the elongate body74 optionally defining an effective length L (FIGS. 43 and 44) betweenthe rider 66 of the adjustment assembly 60 and the adjustment arm 62.Alternatively, the elongate body 74 may optionally define the effectivelength L as the distance between a second surface 112 of the rider 66and the first end 140 of the force directing member 64 (not shown). Theeffective length L is dependent on the position of the adjustmentretainer 70 along the force directing member 64, according to someembodiments. An effective angle α (FIGS. 47 and 49) between the forcedirecting member 64 and a first surface 160 (shown in FIG. 39) of theadjustment arm 62 is optionally dependent on the position of the firstand second rods 12, 14. As the adjustment retainer 70 is engaged, orrotated clockwise (for right hand threaded components), along the forcedirecting member 64, the effective length L is shortened and the angle αis increased as desired (for example, see a1 in FIG. 47). If theadjustment retainer 70 is disengaged, or rotated counter-clockwise (forright hand threaded components), the effective length L is lengthenedand the angle α is decreased as desired (for example, see a2 in FIG.49). Although a screw, or threaded, adjustment mechanism is shown, avariety of alternative adjustment mechanisms (e.g., a pawl and ratchetsystem) are contemplated.

FIGS. 39-42 show features of the adjustment arm 62 (also described as atransverse connector or arm), according to some embodiments. Theadjustment arm 62 is optionally configured to extend from a first side40A of the spine 40 to a second side 40B of the spine 40. As shown, theadjustment arm 62 includes a second rod coupler 150, a connectingportion 152, and a base portion 154, the adjustment arm having a firstend 156, a second end 158, the first surface 160, a second surface 162,and a longitudinal axis X3 extending from the first end 156 to thesecond end 158.

As shown, the connecting portion 152 of the adjustment arm 62 has anelongate body 164 that extends from the base portion 154 to the secondrod coupler 150. In some embodiments, the first surface 160 of theadjustment arm 62 faces generally toward the adjustment assembly 60 andthe second surface 162 of the adjustment arm 62 faces generally away theadjustment assembly 60. In operation, the first surface 160 of theadjustment arm 62 also engages with the adjustment assembly 60 when theadjustment assembly 60 is moved along the force directing member 64 andbrought in contact with the adjustment arm 62, according to someembodiments.

FIG. 39 is a side view of the adjustment arm 62, according to someembodiments. As shown, the second end 158 of the adjustment arm 62includes the second rod coupler 150, which is configured to be securedto a second rod 14 extending longitudinally along a second side 40B of aspine 40. In some embodiments, the second rod coupler 150 of theadjustment arm 62 is substantially similar to the first rod coupler 72of the adjustment assembly 60, with the exception that the second rodcoupler 150 receives the second rod 14. The second rod coupler 150 ofthe adjustment arm 62 is optionally configured to substantially limitroll of the second rod 14 where the second rod 14 is received by thesecond rod coupler 150. As shown in FIG. 39, the second rod coupler 150is adapted to be substantially laterally constrained by the second rod14 with the second rod 14 being able to axially translate through thesecond rod coupler 150 and to pivot in pitch and yaw at the second rodcoupler 150 at a second pivot point P2.

As shown in FIG. 34, a body 168 of the second rod coupler 150 alsoincludes a second protrusion 166 (e.g., a pin) or protrusions (notshown) that extends inwardly into the aperture from the articulationsurface 148. In some embodiments, the second protrusion 166 issubstantially similar to the first protrusion 102 of the first rodcoupler 72, discussed previously herein, and substantially prevents asleeve insert 182 from rolling within the body 168 of the second rodcoupler 150.

As shown in FIG. 39, the second rod coupler 150 of the adjustment arm 62includes a locking mechanism similar to the first rod coupler 72. Insome embodiments, the locking portion 170 has a first portion 172 and asecond portion 174 separated by a gap 176. The first portion 172 and thesecond portion 174 can be locked, or clamped, together with the lockingmember 180 is secured into a through slot 178 and across the gap 176,according to some embodiments. As shown, the sleeve insert 182 also hasa gap 184 (FIG. 34) that facilitates locking of the sleeve insert 182onto the second rod 14. For example, upon sufficiently tightening thelocking member 180, the sleeve insert 182 is optionally locked onto rod14 to substantially arrest axial translation of the second rod 14through the sleeve insert 182. In some embodiments, the locking actionof the body 168 of the second rod coupler 150 on the sleeve insert 182substantially arrests changes in pitch and yaw. In different terms, thesecond rod 14 is able to be selectively locked relative to the firsttransverse coupler 320, in accordance with some embodiments. Theselective locking feature is optionally suitable for constrainingmovement of the rod 14 under conditions associated with implantation ofthe system 100 and/or under conditions associated with spinal loading ofthe system 100 following implantation and securement of the system tothe spine 40.

As mentioned previously and as shown in FIGS. 40 and 41, the first end156 of the adjustment arm 62 includes an articulation aperture 144extending from the first surface 160 to the second surface 162. In someembodiments, the articulation aperture 144 is adapted to receive theforce directing member. The articulate aperture 144 has a revolute,substantially concave inner surface with an elongate opening extendingin the direction of the longitudinal axis X3 (FIGS. 40-42).

As shown in FIGS. 43-46, the elongate body 74 of the force directingmember 64 extends from the first surface 160 of the adjustment arm 62 atan angle relative to the longitudinal axis X3. In some embodiments, theforce directing member 64 extends from first surface 160 of theadjustment arm 62 at an adjustable angle relative to the longitudinalaxis X3. The angle may be, for example, optionally adjusted to any anglebetween 0 to 90 degrees. In some embodiments, the force directing member64 is rigidly secured to the first end 156 of the adjustment arm 62 andextends from the first surface 160 of the adjustment arm 62 at asubstantially fixed angle relative to the longitudinal axis. In someembodiments, the elongate body 74 of the force directing member 64extends from the first surface 160 of the adjustment arm 62 at asubstantially orthogonal angle relative to the longitudinal axis X3.

In some embodiments, the spherically shaped first end 140 of the forcedirecting member 64 fits within an articulation aperture 144. The firstend 140 of the force directing member 64 is optionally received withinthe articulation aperture 144 (FIGS. 40 and 41) of the adjustment arm 62such that the force directing member 64 is able to angulate. In someembodiments, the force directing member 64 is substantially free toangulate in a first plane of angulation A1 (FIGS. 43 and 45) to agreater degree than in other planes of angulation (e.g., a second planeof angulation A2 as shown in FIGS. 44 and 46). The first plane ofangulation A1 is depicted as a line (FIGS. 44 and 46). The first planeA1 is defined by the longitudinal axis X3 and the normal axis X4 of thetransverse coupler, both falling within the first plane A1. The firstplane A1 is generally orthogonal to the second plane A2 while beinggenerally parallel to the longitudinal axis X3 and the normal axis X4.The second plane of angulation A2 is depicted as a line (FIGS. 43 and45), where the first plane A1 extends orthogonally from the second planeA2. The normal axis X4 falls within the second plane A2, the normal axisX4 being generally parallel the second plane A2. In some embodiments,the force directing member 64 is substantially free to angulate in asingle plane of angulation (e.g., the first plane A1) or multiple planesof angulation (e.g., the first plane A1 and the second plane A2) asdesired.

In some embodiments, the force directing member 64 is received withinthe articulation aperture of the adjustment arm 62 such that the forcedirecting member 64 is able to angulate. The force directing member 64is able to optionally articulate in a first plane of angulation A1 to agreater extent than the force directing member 64 is able to angulate ina second plane of angulation A2 that is substantially perpendicular tothe first plane of angulation. In some embodiments, the force directingmember 64 has an angulation range of 90 degree, wherein the forcedirecting member 64 is able to articulate through an angle of about 45degrees or more in the first plane of angulation A1. The force directingmember 64 optionally articulates in the first plane of angulation A1 andis substantially prevented from articulating in the second plane ofangulation A2. It is also contemplated that the force directing member64 is able to articulate in a multiple planes of angulation, accordingto some embodiments.

FIGS. 47-49 show a view of the system 100 taken in a transverse plane tothe spine 40 near the apex of the defective curvature, with someinferior and superior portions of the spine 40 and system 100 not shownto simplify illustration. As shown, the transverse coupler 320 issecured to the first apical vertebra 42 and to the first and the secondrods 12, 14. In sequentially viewing the Figures, it can be seen thatduring operation, the vertebrae 42 is laterally translated and derotatedwhile the transverse coupler 320 is being adjusted, according to somemethods of using the system 10. After the adjustment, the first apicalvertebra 42 is then locked against further rotation or lateral movementby locking the transverse coupler 320 to both the first and the secondrods 12, 14, according to some embodiments. FIGS. 47 and 48 show thevertebra 42 in an uncorrected state, or a partially derotated andlaterally offset state with the first and the second rods 12, 14 securedin first and the second rod couplers 72, 150 of the first transversecoupler 320.

In order to secure the first rod 12 onto the spine 40, the first andsecond stabilizing anchors 16, 18 are optionally secured at an inferiorspinal position, or level, (e.g., to an inferior vertebrae) and asuperior spinal position, or level (e.g., to a superior vertebrae),respectively. In some embodiments, the first rod 12 is substantiallylaterally constrained by the first and second stabilizing anchors 16, 18such that the first rod 12 extends longitudinally on the first side 40Aof the spine 40 and is laterally constrained relative to the inferiorand superior vertebrae.

The second rod 14 is optionally secured on an opposite side of the spineat intermediate positions along the spine by a first intermediate anchorand a second intermediate anchor, for example. The first and secondintermediate anchors are adapted to substantially constrain the secondrod 14 against substantial lateral translation as desired. The firstintermediate anchor (e.g., the fifth stabilizing anchor 23 as shown inFIG. 31) is optionally secured to a first, intermediate vertebrae and asecond, intermediate vertebrae, each located between the superior andinferior vertebrae to which the first and second stabilizing anchors aresecured. In some embodiments, the first and second intermediate anchorsare secured to vertebral bodies located on or adjacent vertebral bodiesthat form an apex, or apical region of the deformity. As shown in FIG.31, with the spine 40 in a generally corrected state, the firstintermediate anchor is positioned at a lower vertebral position, orlevel than the adjustment assembly 60 and at a higher vertebralposition, or level than the first stabilizing anchor 16. In turn, thesecond intermediate anchor (e.g., the sixth stabilizing anchor 25), isoptionally positioned along the spine 40 at a higher vertebral position,or level along the second rod 14 between the adjustment assembly 60 andthe second stabilizing anchor 18.

In order to assemble the transverse coupler 320 onto the system 100(FIG. 31), a physician can optionally articulate components of thetransverse coupler 320 (e.g. the force directing member 64 and theadjustment assembly 60), such that the rod couplers 72, 150 of thetransverse coupler 320 are able to reach the first and the second rods12, 14. Alternatively or additionally, a physician or other user canoptionally employ a variety of tools and associated methods. Forexample, the user can optionally use a surgical tool, such as a wrench,clamp, or gripping tool, compressor, distractor adapted to couple to thefirst rod 12, the second rod 14, the first transverse coupler 320,and/or other spinal devices. The tool is used to assist the physician inderotating and/or translating the spinal column 40 during a correctionas desired. The tool is optionally used to assist the physician inmaintaining a desired configuration while assembling the system 100 ontothe spine 40.

As shown in FIG. 47, the first transverse coupler 320 is assembled ontothe first apical vertebra 42. During assembly, the first and the secondrod couplers 72, 150 of the first transverse coupler 320 are optionallyadjusted to an unlocked state when coupled to the first and the secondrods 12, 14 respectively, such that the physician has free movement asdesired, when assembling the transverse coupler 320 onto the spine 40.In some embodiments, the first and the second rod couplers 72, 150 areadjusted to an unlocked state to reduce binding of the rods 12, 14 andto provide more degrees of freedom to the first transverse coupler 320during the lateral translation and derotation of the spine.

During or after assembly, the transverse coupler 320 is optionallyadjusted to a locked state onto the rods 12, 14 of the system 100 toallow for lateral translation and derotation of the first apicalvertebra 42. In some embodiments, the first and the second rods 12, 14are generally locked against rotation roll within the correspondingcouplers 72, 150 of the first transverse coupler 320, as previouslydiscussed herein. The first rod 12 is optionally left unlocked withinthe first rod coupler 72 while the second rod 14 is locked against axialtranslation and changes in pitch and yaw within the second rod coupler150. In some embodiments, the first rod 12 is able to change in pitchand yaw, while the second rod 14 is substantially constrained againstchanges in pitch, yaw, and roll during at least a portion of thecorrection.

In some embodiments, the first rod 12 is able to axially translate andchange in pitch and yaw about the first pivot point P1 while thevertebra 42 is being laterally translated and derotated during the fullduration of the correction. In other embodiments, the first rod 12 islocked against changes in pitch and yaw during a portion of thecorrection and/or after the correction. FIGS. 47-49 depict a use of thetransverse coupler 320 such that the first rod 12 is able to change inpitch, yaw, and axial translation during a correction and is lockedagainst changes in pitch, yaw, and axial translation after thecorrection, according to some embodiments.

FIG. 48 shows the first apical vertebra 42 in a partially derotated anda laterally offset state and FIG. 49 shows the first apical vertebra 42in a maximally derotated and laterally translated state, according tosome embodiments. The first transverse coupler 320 operates to laterallytranslate and rotate the second rod 14 towards the first rod 12 suchthat a portion of the spine 40 is moved into a more correctconfiguration, in accordance with some embodiments. For example,comparing FIG. 49 to FIG. 47, it can be seen that the distance betweenthe first rod 12 and the second 14 has significantly shortened(identified as D1 and D2 in FIGS. 47 and 49, respectively) after thecorrection. Shown by an arrow in the Figures, the first transversecoupler 320 is optionally adapted to derotate the vertebra 42 andlaterally translate the vertebra 42, either contemporaneously,sequentially, or combinations thereof.

FIG. 49 shows the first apical vertebra 42 maximally derotated andlaterally translated. The transverse coupler 320 is optionally lockedafter the vertebra 42 has been laterally translated and derotated asdesired (e.g., as shown in FIG. 49), to prevent relative translationaland rotational movement between the first rod 12 and second rod 14 tostabilize and hold the vertebra 42 in the corrected position. Additionalanchors 23, 25, 28, 30 are added to the spine 40 as desired to provideadditional stability to the spine 40. In some embodiments, after thevertebra 42 has been laterally translated and/or partially derotated andthe transverse coupler 320 has been locked to the rods, the adjustmentretainer 70 is actuated along the force directing member 64 to derotate,or further derotate, the spine 40.

An illustrative but non-limiting example of correcting a spinal defectincludes securing the first stabilizing anchor 16 at an inferior spinalposition and the second stabilizing anchor 18 at a superior spinalposition along the first side 40A of the spine 40. The first rod 12 isextended longitudinally on the first side 40A of the spine 40 and issubstantially laterally constrained between the first and the secondstabilizing anchors 16, 18, according to some embodiments.

The first anchor 24 is optionally secured at an inferior spinal positionand the second anchor 26 is secured at the superior spinal positionalong the second side 40B of the spine 40. The second rod 14 extendslongitudinally on the second side 40B of the spine 40 and issubstantially laterally constrained between the first and the secondanchors 24, 26, according to some embodiments.

The first transverse coupler 320 is optionally assembled onto the firstand the second sides 40A, 40B of the spinal column 40, either at sometime prior to, during, or after securing the stabilizing anchors 16, 18,24, 26 to the spine 40. In some embodiments, the transverse coupler 320is assembled onto the first side 40A of the spine 40 by coupling thefirst rod coupler 72 of the adjustment assembly 60 to the first rod 12.The first rod 12 is able to axially translate and change in pitch andyaw, but is substantially restricted from lateral translation at thefirst rod coupler 72, according to some embodiments.

The transverse coupler 320 is optionally assembled onto the second side40B of the spine 40 by coupling the second rod coupler 150 of theadjustment arm 62 to the second rod 14. In some embodiments, the secondrod 14 is locked from axial translation and changing in pitch, yaw androll at the second rod coupler 150. The adjustment arm 62 of the firsttransverse coupler 320 is positioned across the first apical vertebra 42such that a connecting portion 152 of an adjustment arm 62 extends fromthe first side 40A of the spine 40 to the second side 40B of the spine40, according to some embodiments.

As previously discussed, the first transverse coupler 320 includes theforce directing member 64 that is optionally the threaded toggle bolt.The force directing member 64 is optionally secured to the adjustmentassembly 60 and the adjustment arm 62 with an initial effective length.

In some embodiments, an adjustment retainer 70 is actuated along theforce directing member 64 by rotating the threaded cap 130 of theadjustment retainer 70 clockwise along a threaded portion of the forcedirecting member 64. Actuating the retainer 70 decreases the effectivelength L as desired. In some embodiments, the effective length L becomesapproximately zero when the adjustment arm 62 becomes seated flushagainst the adjustment assembly 60. The force directing member 64 isoptionally cut or broken off to a shorter length, as desired, during theprocedure as the effective length L decreases from the initial effectivelength.

As the adjustment retainer 70 is optionally actuated along the forcedirecting member 64, the rider 66 provides a resistance force thattransmits through the force directing member 64 to the adjustment arm62. In some embodiments, the resistance force causes the second rod 14to move towards the first rod 12, which laterally translates a portionof the spine 40 towards the first rod 12.

In some embodiments, the adjustment retainer 70 is actuated along thefirst force directing member 64 such that the first surface 160 of theadjustment arm 62 comes into contact with the adjustment assembly 60.The adjustment retainer 70 is then optionally further actuated to pivotthe rider 66 and the adjustment arm 62 towards each other such that thefirst surface 160 of the adjustment arm 62 becomes seated flush againstthe second surface 112 of the rider 66. In some embodiments, theadjustment assembly 60 receives the force directing member 64 within anarticulation aperture 144 having an elongate transverse cross-section,allowing the force directing member 64 to articulate in the first planeof angulation as the adjustment retainer 70 is driven along the firstforce directing member 64. As the adjustment assembly 60 and theadjustment arm 62 impinge and ultimately become seated together, theforce directing member 64 articulates into a generally orthogonal anglerelative to the longitudinal axis X3 defined by the adjustment arm 62,according to some embodiments. In some embodiments, as the forcedirecting member 64 articulates, the first apical vertebra 42 derotates.Once the adjustment arm 62 and the adjustment assembly 60 are broughtinto the desired amount of contact or the desired effective length L ofthe force directing member 64 has been achieved.

FIG. 50 shows an isometric view of an alternative embodiment of a firsttransverse coupler 200 of the system 100, also described as a transverseconnector. The first transverse coupler 200 is optionally adapted, orotherwise structured, to be positioned laterally across one or more ofthe vertebrae, such as the first apical vertebra 42 (FIG. 31) located ator near an apical position along the spine 40. As shown, the firsttransverse coupler 200 is adapted to extend from the first side 40A ofthe spine 40 toward, and ultimately across to the second side 40B of thespine 40.

As shown, the first transverse coupler 200 includes features that aresubstantially similar to the first transverse coupler 320. In someembodiments, the adjustment arm 202 is substantially similar to theadjustment arm 62 of the first transverse coupler 320, and thus variousfeatures of the adjustment arm 62 of the first transverse coupler 320also apply to the adjustment arm 202 of the first transverse coupler200.

As shown in FIG. 50, the first transverse coupler 200 includes anadjustment assembly 250 adapted to be secured to a first rod 12. In someembodiments, the adjustment assembly 250 includes a rider 252, anadjustment retainer 254, and a first rod coupler 256 to receive thefirst rod 12.

FIGS. 51-53 show a top, a side and a rear view of the first transversecoupler 200. In some embodiments, the rider 252 and the adjustmentretainer 254 of the first transverse coupler 200 engage with anadjustment arm 202 and/or a force directing member 204 in a mannersubstantially similar to the rider 66 and adjustment retainer 70 of thefirst transverse coupler 320. The various features of the rider 66 andthe adjustment retainer 70 of the first transverse coupler 320 alsoapply to the rider 252 and the adjustment retainer 254 of the firsttransverse coupler 200. The main difference between the first transversecoupler 200 and the first transverse coupler 320 is the first rodcoupler 256, according to some embodiments.

As shown in FIGS. 50 and 53, the first rod coupler 256 includes a headportion 258 is substantially U-shaped (similar to the U-shaped head 142of the first anchor 20 discussed above with respect to FIG. 1) having afirst prong 262 and a second prong 264 defining a pocket 266 forreceiving the first rod 12. The head portion 258 of the adjustmentassembly 250 serves to couple the first transverse coupler 200 to thefirst rod 12. As shown, the prongs 262, 264 are threaded for receiving aclamping screw 268 adapted to engage and secure the first rod 12immobilized within the pocket 266. The first rod coupler 256 of theadjustment assembly 250 is optionally configured to receive the firstrod 12 such that the first rod 12 is free to change in at least rollwithin the first rod coupler 256. In some embodiments, first rod coupler256 is configured to receive the first rod 12 such that the first rod 12is free to change in pitch and roll, but is substantially limited fromchanges in yaw within the first rod coupler 256. In some embodiments,the first rod coupler 256 is configured to be transitioned from anunlocked state in which the first rod 12 is free to move in at least oneof slide, pitch, yaw or roll with respect to the first rod coupler 256to a locked state. In some embodiments, the first rod 12 is received bythe first rod coupler 256 such that the first rod coupler 256 becomessubstantially laterally constrained by the first rod 12. The first rodcoupler 256 optionally locks the first rod 12 against axial translation,changes in pitch, yaw and roll about a rod pivot point with respect tothe first rod coupler 256.

FIG. 54 provides another alternative embodiment of the first transversecoupler 300, which includes an adjustment assembly 350 adapted to besecured to a first rod 12. In some embodiments, the adjustment assembly350 includes a rider 352, an adjustment retainer 354, and a first rodcoupler 358 to receive the first rod 12. The first rod coupler 358optionally receives the first rod 12 in a substantially similar mannerto the adjustment assembly 250 of the first transverse coupler 200, andtherefore various features of the adjustment assembly 250 of the firsttransverse coupler 200 also apply to the adjustment assembly 350 of thefirst transverse coupler 300. The primary difference between the firsttransverse coupler 300 and the first transverse coupler 200 is thedesign of the second rod coupler 312 of the adjustment arm 302,according to some embodiments.

As shown in FIG. 54, the adjustment arm 302 is substantially similar tothe adjustment arm 62 of the first transverse coupler 320 with adifference of having a second rod coupler 312 that includes a U-shapedhead portion 314. The head portion 314 is substantially U-shaped andincludes a first prong 306 and a second prong 308 that defines a pocket310 for receiving the second rod 14. The head portion 314 of theadjustment arm 302 serves to couple the first transverse coupler 300 tothe second rod 14. As shown, the prongs 306, 308 are optionally threadedfor receiving a clamping screw (not shown) adapted to engage and securethe second rod 14 immobilized within the pocket 310. The second rodcoupler 312 receives the second rod 14 similar to how the first coupler356 receives the second rod 14, and therefore those various features ofthe first rod coupler 256 are also applicable to the second rod coupler312 with respect to the second rod 14.

FIG. 55 shows an isometric view of another first transverse coupler 400of the system 10, also described as a fixed transverse coupler. Thefirst transverse coupler 400 is optionally adapted, or otherwisestructured, to be positioned laterally across one or more of thevertebrae, such as the first apical vertebra 42 (FIG. 31) located at ornear an apical position along the spine 40. As shown, the firsttransverse coupler 200 is adapted to extend from the first side 40A ofthe spine 40 toward, and ultimately across to the second side 40B of thespine 40.

As shown, the first transverse coupler 400 includes features that aresubstantially similar to the first transverse coupler 320. In someembodiments, the first transverse coupler 400 includes an adjustmentassembly 450 adapted to be secured to a first rod 12. In someembodiments, the adjustment assembly 450 includes a rider 452, anadjustment retainer 454, and a first rod coupler 456 to receive thefirst rod 12. In some embodiments, the adjustment assembly 450 issubstantially similar to the adjustment assembly 60 of the firsttransverse coupler 320.

The first transverse coupler 400 optionally includes an adjustment arm402 with a second rod coupler 412 adapted to be secured to the secondrod 14 and extends from the first side 40A of the spine 40 to the secondside 40B of the spine 40. In some embodiments, the adjustment arm 402has a first end 406 and a second end 408 and a longitudinal axis X3extending between the first and the second ends 406, 408. The adjustmentarm 402 optionally has a first surface 414 and a second opposite surface416 (FIG. 56).

FIG. 56 shows a view of the adjustment arm 402, with some features notshown to facilitate understanding, which is substantially similar to theadjustment arm 62 of the first transverse coupler 320 with a differenceof having a force directing member 404 rigidly secured to the first end406 of the adjustment arm 402. In some embodiments, the force directingmember 404 extends from the first surface 414 of the adjustment arm 402at a generally orthogonal angle relative to the longitudinal axis X3. Inother embodiments, the force directing member 404 extends from the firstsurface 414 of the adjustment arm 402 at a non-orthogonal angle relativeto the longitudinal axis X3. The force directing member 404 has anelongate body 410 extending between the adjustment assembly 450 and theadjustment arm 402, according to some embodiments.

The adjustment arm 402 optionally includes an elongated portion 418 withan aperture 420 at the first end 406 of the adjustment arm 402. Theaperture 420 is optionally adapted to receive at least a portion of asurgical tool that may be used during the implant procedure to obtainand hold a spinal correction.

FIGS. 57-59 show a view of the system 100 taken in a transverse plane tothe spine 40 near the apex of the defective curvature, with someinferior and superior portions of the spine 40 and system 100 not shownto simplify illustration. As shown, the transverse coupler 400 issecured to the first apical vertebra 42 and to the first and the secondrods 12, 14. In sequentially viewing the Figures, it can be seen thatduring operation, the first apical vertebra 42 is laterally translatedand derotated while the transverse coupler 400 is being adjusted,according to some methods of using the system 10. FIGS. 57 and 58 showthe first apical vertebra 42 in a partially derotated and a laterallyoffset state and FIG. 59 shows the first apical vertebra 42 maximallyderotated and laterally translated.

In order to assemble the transverse coupler 400 onto the system 100(FIG. 31), a physician can optionally angulate the adjustment assembly450 of the transverse coupler 200 (e.g.) such that the rod couplers 456,412 of the transverse coupler 400 are able to reach the first and thesecond rods 12, 14. Alternatively or additionally, a physician or otheruser can optionally employ a variety of tools and associated methods.For example, the user can use a surgical tool, such as a wrench, clamp,or gripping tool, adapted to couple to the first rod 12, the second rod14, the first transverse coupler 400, and/or other spinal devices asdesired. In some embodiments, the surgical tool optionally assists thephysician in derotating and/or translating a spinal column 40 during acorrection. The surgical tool optionally assists the physician inmaintaining a desired configuration while assembling the system 100 ontothe spine 40.

A spinal correction using the first transverse coupler 200 as shown inFIGS. 57-59 optionally proceeds similarly to the spinal correction usingthe transverse coupler 320 as shown in FIGS. 43-46.

An illustrative but non-limiting example of correcting a spinal defectusing the first transverse coupler 400 is provided herein. Stabilizinganchors 16, 18, anchors 24, 26, and rods 12, 14 are optionally securedto the spine 40 using the operation as discussed previously.

The first transverse coupler 200 is assembled onto the first and thesecond sides 40A, 40B of the spinal column 40, either at some time priorto, during, or after securing the stabilizing anchors 16, 18, 24, 26 tothe spine 40. In some embodiments, the transverse coupler 400 isassembled onto the first side 40A of the spine 40 by coupling the firstrod coupler 456 of the adjustment assembly 250 to the first rod 12. Thefirst rod 12 is able to axially translate and change in pitch and yaw,but is substantially restricted from translating laterally at the firstrod coupler 456, according to some embodiments.

The transverse coupler 400 is optionally assembled onto the second side40B of the spine 40 by coupling the second rod coupler 412 of theadjustment arm 402 to the second rod 14. In some embodiments, the secondrod 14 is locked from axial translation and changing in pitch, yaw androll at the second rod coupler 412. The adjustment arm 402 of the firsttransverse coupler 400 is be positioned across the first apical vertebra42 such that a connecting portion 422 of an adjustment arm 402 extendsfrom the first side 40A of the spine 40 to the second side 40B of thespine 40, according to some embodiments.

As previously discussed, the first transverse coupler 400 optionally hasthe force directing member 404 rigidly coupled to the adjustment arm402. In some embodiments, the adjustment retainer 454 is actuated alongthe force directing member 404 by rotating a threaded cap 455 of theadjustment retainer 454 clockwise along a threaded portion of the forcedirecting member 404. Actuating the adjustment retainer 454 decreases aneffective length L (FIG. 57) of the force directing member 404 asdesired. In some embodiments, the effective length L becomesapproximately zero when the adjustment arm 402 becomes seated flushagainst the adjustment assembly 450. In other words, actuating theretainer 454 optionally changes the distance and orientation of therider 452 with respect to the adjustment arm 402. In some embodiments,actuating the retainer 454 optionally couples the rider 452 to theadjustment arm 402. The force directing member 404 is optionally cut orbroken off to a shorter length, as desired, during the procedure as theeffective length L decreases from the initial effective length.

As the adjustment retainer 454 is optionally actuated along the forcedirecting member 404, the rider 452 provides a resistance force thattransmits through the force directing member 404 to the adjustment arm402. In some embodiments, the resistance force causes the second rod 14to move towards the first rod 12, which laterally translates a portionof the spine 40 towards the first rod 12.

In some embodiments, the adjustment retainer 454 is actuated along thefirst force directing member 404 such that the first surface 414 of theadjustment arm 402 comes into contact with the adjustment assembly 450.The adjustment retainer 454 is then optionally further actuated to pivotthe rider 452 and the adjustment arm 402 towards each other such thatthe first surface 414 of the adjustment arm 402 becomes seated flushagainst a second surface 460 of the rider 452. As the adjustmentassembly 450 and the adjustment arm 402 impinge and ultimately becomeseated together, according to some embodiments. Once the adjustment arm402 and the adjustment assembly 450 are brought into the desired amountof contact or the desired effective length L of the force directingmember 404 has been achieved.

As discussed above, if desired, the secondary stabilization rod can befastened to promote a fusion process at one or more designated spinalsegments, and thereby prohibit any freedom of motion at any of the oneor more designated spinal segments. However, spinal fusion of segmentsat various levels may not be desirable in certain spinal deformityscenarios. For example, Early Onset Scoliosis (EOS) is a progressivespinal deformity in young children. In various situations, such as someforms of EOS, correcting the deformity with definitive fusion ofvertebrae may not be desirable, including where vertebral fusion canstunt, or otherwise inhibit patient growth, for example.

Accordingly, some embodiments relate to spinal correction systems thatprovide means for maintaining a correction to facilitate spinalremodeling while minimizing or in the absence of substantial vertebralfusion. In some embodiments, the spine retains freedom of motion (in oneor more degrees of freedom) above (superior to) and below (inferior to)the spinal segment undergoing correction (such as a target region orapical region), and additionally retains freedom of motion (in one ormore degrees of freedom) along the spinal segment undergoing correction.

FIG. 60 illustrates a spinal correction system 1000 that provides spinalstability and correction of a target apical region in the presence ofminimal or no vertebral fusion. Similar to various above-discussedembodiments, the spinal stabilization system 1000 illustrated in FIG. 60includes a plurality of rod anchors, also described as stabilizinganchors (16, 18, 20, 22, 24, 26, 28, and 30), which are optionallysubstantially similar to the above-discussed stabilizing anchors, and aplurality of fasteners 36, such as bone screws or pedicle screws, forsecuring components of the system 1000 to a spine 40 having a first side40A and a second side 40B. In some embodiments, one or more of thestabilizing anchors (e.g., 16, 18, 20, 22, 24, 26, 28, and 30) providemeans for allowing first rod 12 and/or second rod 14 to angulate withoutsubstantial lateral translation relative to the stabilizing anchor andwithout substantial rotation about the longitudinal axis X. Asindicated, depending upon implementation, the stabilizing anchors 16,18, 20, 22, 24, 26, 28, and 30 are optionally any ofpreviously-discussed anchors, or stabilizing anchors that, in turn,allow the first rod 12 and second rod 14 to slide axially, or otherwisetranslate axially, along the longitudinal axis relative to thestabilizing anchors (16, 18, 20, 22, 24, 26, 28, and 30) through pivotpoints associated with each of the stabilizing anchors. In someembodiments, rod 12 and/or rod 14 are able to change in pitch, yaw, androll about each of the pivot points associated with each of thestabilizing anchors. In other embodiments, rod 12 and/or rod 14 are ableto change in pitch, yaw, and roll about some of the various pivotpoints. In yet other embodiments, one or more of the stabilizing anchors(e.g., 16, 18, 20, 22, 24, 26, 28, and 30) are additionally oralternatively adapted, or otherwise structured, to limit rotation, orroll, of the first rod 12 and/or second rod 14 about the longitudinalaxis X (e.g., X1 or X2) of the respective rod.

As is illustrated in FIG. 60, stabilizing anchors 16, 18, 20, and 22 arepositioned along the first side 40A of the spinal column 40 and areoptionally secured to the spine 40 using one or more of the methods orconfigurations discussed herein. Stabilization 16, 18, 20, and 22 eachhave a pivot point associated therewith (such as pivot point P1disclosed herein). Moreover, stabilizing anchors 16, 18, 20, and 22, arecoupled to the first rod 12 (such as according to the embodimentsdescribed herein). In some embodiments, rod 12 is free to changeposition axially, rotationally, or angularly (e.g., pitch, yaw, and/orroll) relative to stabilizing anchors 16, 18, 20, and 22 at one or moreof the pivot points associated with the individual anchors. However, inthis illustrated example, rod 12 is constrained from any substantiallateral translation (medial-lateral and/or anterior-posteriortranslation) as previously described.

As is further illustrated in FIG. 60, a plurality of stabilizing anchors24, 26, 28, and 30, are additionally positioned along the second side40B of the spinal column 40 and are adapted to interface with second rod14. Similar to stabilizing anchors 16, 18, 20, and 22, stabilizinganchors 24, 26, 28, and 30 each have a pivot point associated therewithand include any of the previously described anchor designs orstabilizing anchor designs and are optionally secured to the spine 40using one or more of the methods or configurations described herein. Insome embodiments, rod 14 is free to change position axially,rotationally, or angularly (e.g., pitch, yaw, and/or roll) relative toone or more of the stabilizing anchors 24, 26, 28, and 30. However, inthis illustrated example, rod 14 is constrained from any substantiallateral translation (medial-lateral or anterior-posterior translation)as previously described.

Spinal correction system 1000 additionally includes a transverse coupler3200 positioned along, and secured to each of rods 12 and 14. In someembodiments, the transverse coupler 3200 is optionally adapted, orotherwise structured, to be positioned laterally across one or more ofthe vertebrae 42 and located at or near an apical position along thespine 40 (thereby linking a concave and a convex side of the spine). Forexample, as is illustrated in FIG. 60, the transverse coupler 3200 isadapted to extend from the first side 40A of the spine 40 toward, andultimately across to the second side 40B of the spinal column 40,thereby establishing a link between the first rod 12 and the second rod14. In some embodiments, the transverse coupler 3200 is configured tosubstantially prevent changes in pitch, yaw, roll, and axial sliding byone or both of the rods 12, 14 with respect to the transverse coupler3200 to effectively constrain all relative degrees of freedom of thefirst rod 12 and the second rod 14 at or around the targeted apicalregion of the spinal column 40. For example, as discussed further below,the transverse coupler 3200 is operable to stabilize deformities againstprogression in each of the coronal, sagittal, and axial planes, therebyprohibiting apical translation, kyphotic changes and axial rotationswhile allowing the vertebrae to have at least one degree of freedom thatallows movement, change in alignment, and/or growth, according to someembodiments.

As shown, the transverse coupler 3200 includes features that aresubstantially similar to those discussed above with respect totransverse coupler 200. For example, in some embodiments, transversecoupler 3200 includes an adjustment arm 3202 adapted to be coupled tothe second rod 14, the adjustment arm 3202 being similar to theabove-discussed adjustment arm 202 of the transverse coupler 200. Thus,various features of the adjustment arm 202 of the transverse coupler 200also apply to the adjustment arm 3202 of the transverse coupler 3200.

Additionally, as shown in FIG. 60, the transverse coupler 3200 includesan adjustment assembly 3250 adapted to be secured to the first rod 12,the adjustment assembly being similar to the above-discussed adjustmentassembly 250 of the transverse coupler 200. Thus, various features ofthe adjustment assembly 250 of the transverse coupler 200 also apply tothe adjustment assembly 3250 of the transverse coupler 3200. While notillustrated, it should be appreciated that, in some embodiments,adjustment assembly 3250 of transverse coupler 3200 includes the same orsimilar features discussed above with respect to adjustment assembly 250of transverse coupler 200 (such as, for example, a rider and a headportion having a pocket and one or more prongs).

As shown in FIG. 60, the transverse coupler 3200 additionally includes aforce directing member 3204 and an adjustment retainer 3254. Asdiscussed above with respect to transverse coupler 200, the forcedirecting member 3204 (which is similar to force directing member 204 oftransverse coupler 200) and the adjustment retainer 3254 (which issimilar to adjustment retainer 254 of transverse coupler 200) areadapted to rigidly couple the adjustment assembly 3250 to the adjustmentarm 3200.

Specifically, in some embodiments, the adjustment retainer 3254 engageswith adjustment arm 3202 and/or force directing member 3204 in a mannersubstantially similar to that discussed above with respect to transversecoupler 200 (such as via a rider). In some embodiments, variousadditional features of the transverse coupler 200 also apply totransverse coupler 3200.

In some embodiments similar to those discussed above with respect totransverse coupler 200, transverse coupler 3200 (as specificallyadjustment assembly 3250) optionally receives the first rod 12 in asubstantially similar manner to the adjustment assembly 250. Therefore,various features of the adjustment assembly 250 of the first transversecoupler 200 also apply to the adjustment assembly 3250. Similarly, insome embodiments, adjustment arm 3202 additionally receives the secondrod 14 similar to how the transverse coupler 200 receives the second rod14. Therefore, various features of the transverse coupler 200 (ortransverse coupler 400) are also applicable to adjustment arm 3202.

During operation of the spinal correction system 1000, apical vertebraeare laterally translated and/or derotated while the transverse coupler3200 is being adjusted (see, e.g., the methods and configurationsdiscussed above). For example, in order to assemble the transversecoupler 3200 onto the spinal correction system 1000 (FIG. 60), aphysician can optionally angulate the adjustment assembly 3250 of thetransverse coupler 3200 such that the transverse coupler 3200 extends toreach (or otherwise interface with) the first and the second rods 12,14. Alternatively or additionally, a physician or other user can employa variety of tools and associated methods. For example, the user canemploy a surgical tool, such as a wrench, clamp, or gripping tool,adapted to couple to the first rod 12, the second rod 14, the transversecoupler 3200, and/or other spinal devices as desired. In someembodiments, the surgical tool optionally assists the physician inderotating and/or translating a spinal column 40 during a correction.The surgical tool optionally assists the physician in maintaining adesired configuration while assembling the spinal correction system 1000onto the spine 40.

In some embodiments, the first transverse coupler 3200 is assembled ontothe first and the second sides 40A, 40B of the spinal column 40, eitherat some time prior to, during, or after securing the stabilizing anchors16, 18, 20, 22, 24, 26, 28, and 30. In some embodiments, the first rod12 may axially translate and change in pitch, yaw, and/or roll relativeto stabilizing anchors 16, 18, 20, and 22, but is substantiallyrestricted from changing position (axial and/or lateral translation,pitch, yaw, and/or roll) relative to the transverse coupler 3200.

In some embodiments, the transverse coupler 3200 is additionally oralternatively assembled onto the second side 40B of the spine 40 bycoupling the adjustment arm 3202 to the second rod 14. The adjustmentarm 3202 is positioned across one or more apical vertebra and interfaceswith adjustment assembly 3250 (e.g., via a force directing member and aretainer, as discussed above) such that the transverse coupler 3200extends from the first side 40A of the spine 40 to the second side 40Bof the spine 40. In some embodiments, the second rod 14 is substantiallyrestricted from changing position (axial and/or lateral translation,pitch, yaw, and/or roll) relative to the adjustment arm 3202.

Once assembled, the transverse coupler 3200 rigidly links first rod 12to second rod 14. Put differently, in some embodiments, because firstrod 12 is rigidly coupled to adjustment assembly 3250 and adjustment arm3202 is rigidly coupled to second rod 14, and because adjustmentassembly 3250 and adjustment arm 3202 are rigidly connected together,first rod 12 is rigidly fixed with respect to second rod 14. It shouldbe appreciated, however, that in various alternative embodiments, rods12 and 14 are operable to change position (axially, rotationally, orangularly) relative to one another.

As discussed above and as illustrated in FIG. 60, the spinal correctionsystem 1000 includes a plurality of stabilizing anchors 16, 18, 20, and22, positioned along the first side 40A of the spinal column 40, and aplurality of stabilizing anchors 24, 26, 28, and 30 positioned along thesecond side 40B of the spinal column 40. While each of stabilizinganchors 16 and 18, as illustrated, are adapted, or otherwise structured,to be mounted or secured to a plurality of the vertebrae, it should beappreciated that each of stabilizing anchors 16 and 18 may bealternatively adapted, or otherwise structured, to be mounted or securedto a single vertebra. Similarly, while each of stabilizing anchors 20,22, 24, 26, 28, and 30, as illustrated, are adapted, or otherwisestructured, to be mounted or secured to a single vertebra, it should beappreciated that each of stabilizing anchors 20, 22, 24, 26, 28, and 30,may be alternatively adapted, or otherwise structured, to be mounted orsecured to a plurality of vertebrae. In some embodiments, one or more ofstabilizing anchors 20, 22, 24, 26, 28, and 30 are adapted to anchor tothe vertebrae with a vertebral anchor coupling. However, it should beappreciated that one or more of the stabilizing anchors 20, 22, 24, 26,28, and 30 may be alternatively adapted to attach directly to thevertebra as depicted by stabilizing anchors 24, 26, 28, 30. In otherwords, any suitable method for securing the stabilizing anchors to thespinal column is envisioned.

As is illustrated in FIG. 60, stabilizing anchors 24 and 28 arepositioned along second rod 14 below (or inferior to) transverse coupler3200. In some embodiments, stabilizing anchors 24 and 28 are coupled toone or more of the patient's vertebrae. For example, stabilizing anchor24 is adapted, or otherwise structured, to be mounted, or fixed to oneor more of the vertebrae 42, such as a first vertebra 42A (FIG. 60)located along the spine 40. Similarly, stabilizing anchor 28 is adaptedto be fixed, and provides means for fixation to a second vertebra, suchas a second vertebra 42C (FIG. 60). In some embodiments, stabilizinganchor 28 is substantially similar to the stabilizing anchor 24,including any desired combination of previously-described features. Insome embodiments, stabilizing anchors 24 and 28 are further adapted toreceive, and provide means for receiving the second rod 14 such thattranslational movement of the second rod 14 is limited except along thelongitudinal axis X2. The second rod 14, in some embodiments, may alsochange in at least pitch, yaw, and/or roll about pivot points P24 andP28 (FIG. 60).

Additionally, as is illustrated in FIG. 60, stabilizing anchors 26 and30 are positioned along second rod 14 above (or superior to) transversecoupler 3200. In some embodiments, stabilizing anchors 26 and 30 arecoupled to one or more of the patient's vertebrae. For example,stabilizing anchor 26 is adapted, or otherwise structured, to bemounted, or fixed to one or more of the vertebrae 42 (or vertebralbody), such as a third vertebra 42B (FIG. 60) located along the spine40. Similarly, stabilizing anchor 30 is adapted to be fixed, andprovides means for fixation to a fourth vertebra, such as a fourthvertebra 42D (FIG. 60). In some embodiments, stabilizing anchors 26 and30 are each further adapted to receive, and provide means for receivingthe second rod 14 such that the stabilizing anchors 26 and 30 limittranslational movement of the second rod 14 except along thelongitudinal axis X2. The second rod 14, in some embodiments, may alsochange in at least pitch, yaw, and/or roll about pivot points P26 andP30.

In some embodiments, stabilizing anchors 24, 26, 28, and 30 are operableto independently change axial, rotational, and/or angular positionalong/about second rod 14, relative to one another. For example,stabilizing anchor 24 (positioned along second rod 14) is operable tochange positions from a first position along rod 14 relative tostabilizing anchors 26, 28, and 30 to a second, different position alongrod 14 relative to stabilizing anchors 26, 28, and 30. Thus, becausestabilizing anchors 24, 26, 28, and 30 are coupled to vertebrae 42A,42B, 42C, and 42D, respectively, according to the example above, thespinal correction system 1000 provides that vertebra 42A can change itsposition along the longitudinal axis of the spinal column 40 and/oralignment (e.g., axial, angular, and/or rotational) relative to one ormore of vertebrae 42B, 42C, and 42D.

By providing a spinal correction system 1000 that allows each vertebraeto change axial position along the longitudinal axis of the spinalcolumn 40 and/or alignment relative to one or more other vertebra, thespinal column system 40 helps allow the spinal column 40 to grow (orotherwise expand) along its longitudinal axis, and thereby helps avoidoverly restricting a patient's growth (i.e., spinal column growth). Insome embodiments, the patient's spinal column grows according to acurvature defined by each of rods 12 and 14. Put differently, becauseeach of rods 12 and 14 act as guides along which stabilizing anchors arepermitted to axially translate, the patient's spinal column growth isgoverned, at least in part, by rods 12 and 14.

By permitting certain of the components of spinal correction system 1000to change position (axially, rotationally, and/or angularly), the spinalcorrection system 1000 provides for various degrees of freedom.Enhancing the degrees of freedom of the system helps maximize motion ofthe spinal column 40 while minimizing system constraint. In someembodiments, the system 1000 permits flexion, extension, and axialrotation, as well as left side and right side bending, where leftbending is facilitated by axial shortening on the left side and axiallengthening on the right side.

It should be appreciated that while the constrained vertebrae (such asvertebrae 42A, 42B, 42C, and 42D) are free to change axial positionrelative to one another, constrained vertebrae are also free, in someembodiments, to change in at least axial position relative to othervertebrae in the spinal column 40.

In some alternative embodiments, the spinal correction system 1000maintains certain of the above-discussed vertebral degrees of freedomwhile providing the spinal column system 1000 with certain additionalconstraints. For example, in some embodiments, although not illustrated,the transverse coupler 3200 is coupled to (or otherwise fixed to) avertebra of the spinal column 40. Accordingly, the transverse coupler3200 and the vertebrae to which it is fixed are constrained fromchanging axial position relative to one another (although in variousembodiments, certain additional degrees of freedom remainunconstrained). In addition to the first and second rods 12 and 14 beingconstrained relative to one another and constrained relative to thetransverse coupler 3200 (as discussed above), the first and second rods12 and 14 are optionally also constrained from changing at least axialposition relative to the vertebrae to which the transverse coupler 3200is fixed.

Although not illustrated in the accompanying figures, the transversecoupler 3200, in some embodiments, is fixed to a fifth vertebra 42E thatis positioned axially along the longitudinal axis of the spinal column40 between vertebrae 42C and 42D such that fifth vertebra 42E isconstrained from changing position (axially, laterally, rotationally, orangularly) relative to the transverse coupler 3200. Under such aconfiguration, although vertebra 42E is fully constrained relative tothe transverse coupler 3200, the other vertebrae constrained by thespinal correction system 1000 (e.g., 42A, 42B, 42C, and 42D) are free tochange axial position relative to the fully constrained vertebra 42E.Put differently, each and every vertebrae located above (superior to)the fully constrained vertebra 42E (including vertebrae 42B and 42D) arefree to change in at least their axial position (and additionally invarious embodiments, their rotational and angular positions) relative tofully constrained vertebra 42E. Similarly, each and every vertebraelocated below (inferior to) the fully constrained vertebra 42E(including vertebrae 42A and 42C) are free to change in at least theiraxial position (and additionally in various embodiments, theirrotational and angular positions) relative to fully constrained vertebra42E. Moreover, each of the vertebrae located above (superior to) andbelow (inferior to) the fully constrained vertebrae 42E is free tochange at least their axial position along the longitudinal axis of thespinal column relative to one another. Thus, this alternative spinalcorrection system 1000 helps allow the spinal column 40 to grow (orotherwise expand) along its longitudinal axis yet constrains each ofrods 12 and 14 from changing axial positioning relative to at least onedesignated vertebrae of the spinal column 40. This alternative spinalcorrection system similarly helps avoid artificially restricting apatient's growth (i.e., spinal column expansion). It should beappreciated that, in various embodiments, the transverse coupler 3200 isoperable to be fixed to a plurality of vertebrae.

In other embodiments, the spinal correction system 1000 includes aplurality of stabilizing anchors, also described as rod anchors that areconfigured to permit axial translation on one side of the spinal columnwhile restricting, or otherwise preventing, axial translation on anotherside of the spinal column. For example, referring again to FIG. 60,though not shown, in some embodiments, each of the stabilizing anchors16, 18, 20, and 22 (positioned along the first side 40A of the spinalcolumn 40), are operable to allow for at least axial translation alongfirst rod 12 (as is discussed above). However, in these embodiments, oneor more of the stabilizing anchors 24, 26, 28, and 30 (positioned alongthe second side 40B of the spinal column 40), such as stabilizinganchors 28 and 30, are restricted from axial translation along secondrod 14. Although the first side 40A of the spinal column 40 at vertebrae42C and 42D is free to expand (or alternatively contract), the secondside 40B of the spine at vertebrae 42C and 42D is constrained bystabilizing anchors 28 and 30 from expanding (or alternativelycontracting). Accordingly, in this embodiment, as the first side 40A ofthe spinal column 40 at vertebrae 42C and 42D expands relative to thesecond side 40B of the spinal column 40 at vertebrae 42C and 42D, aconcave curvature otherwise existing on the first side 40A of the spinalcolumn 40 at vertebrae 42C and 42D is reduced (or is otherwiseeliminated). Similarly, as first side 40A of the spinal column 40 atvertebrae 42C and 42D expands relative to the second side 40B of thespinal column 40 at vertebrae 42C and 42D, a convex curvature otherwiseexisting on the second side 40B of the spinal column 40 at vertebrae 42Cand 42D is reduced (or is otherwise eliminated).

It should be generally understood that, in some embodiments, the spinalcorrection system 1000 can be configured (or implemented) such that thefirst rod 12 longitudinal axis X1 and the second rod 14 longitudinalaxis X2 converge at one end and diverge at another. Put differently,under this configuration, a longitudinal axis X2 along which the secondrod 14 extends is not parallel to a longitudinal axis X1 along which thefirst rod 12 extends. It should be appreciated that, in theseembodiments, alteration of the alignment between axes X1 and X2 providesfor correction of a spinal deformity as would be understood by one ofordinary skill.

While certain of the above discussed embodiments provide for a spinalcorrection system 1000 that allows a first side 40A and a second side40B of a spinal column 40 to expand (or alternatively contract) relativeto one another, various alternative embodiments provide additionalconfigurations for a spinal correction system 1000 that permits thespinal column 40 to grow on the first side 40A while restricting orminimizing growth on the second side 40B. In such embodiments, a spinalcorrection system 1000 includes stabilization anchors 16, 18, 20 and 22that allow the first rod 12 to slide axially on the first side 40A whilestabilization anchors 24, 26, 28 and 30 to restrict the second rod 14 toslide axially on the second side 40B.

In some embodiments, such a spinal correction system 1000 includes aplurality of transverse couplers 3200. For example, the spinalcorrection system 1000 illustrated in FIG. 61 includes a plurality oftransverse couplers 3200A and 3200B. In some embodiments, eachtransverse coupler (3200A and 3200B) extends across the spinal column 40from the first side 40A to the second side 40B. Additionally, eachtransverse coupler (3200A and 3200B) is coupled to rods 12 and 14. Inthe illustrated example, transverse coupler 3200B is located at asuperior position relative to transverse coupler 3200A, such that anapical region 5200 of the spinal column 40 is situated betweentransverse coupler 3200A and 3200B. Accordingly, rods 12 and 14 areconstrained laterally, axially, rotationally, and angularly relative toone another. It should be appreciated that stabilizing anchors depictedin these illustrative embodiments are not meant to be limiting in thatany suitable anchor disclosed herein, including rod anchors (alsodescribed as stabilizing anchors) can be utilized.

For example, while the stabilizing anchors 24 and 26 depicted in FIG. 61provide for a configuration where rod 14 is in a different lateralposition relative to rod 14 as depicted in the configuration of FIG. 60,the transverse coupler configuration depicted in FIG. 61 may beimplemented in accordance with any stabilizing anchor (i.e., anchor)disclosed herein to achieve any desired configuration having any desiredlateral offset relative to a longitudinal axis of the patient's spinalcolumn. In other words, the spinal corrective systems and correspondingcomponents disclosed herein provide for both offset (FIG. 61) andnon-offset (FIG. 60) configurations. Moreover, in some embodiments, byimplementing a plurality of transverse couplers 3200, the spinalcorrection system 1000 is operable to control a larger apical region ordeformity. Further, in some embodiments, by implementing a plurality oftransverse couplers 3200, the spinal correction system 1000 can beconfigured to span multiple motion segments (such as multiple vertebra)while maintaining a desired degree of stability and control. While theseembodiments are described in association with the utilization of twotransverse couplers, it should be appreciated that one or more (such asmore than two) transverse couplers may be utilized to stabilize andcontrol one or more motion segments of a patient's spinal column.

Moreover, one or more rod stops may be implemented in accordance withany of the spinal correction systems disclosed herein. For example, FIG.61 illustrates a plurality of rod stops 35 positioned along each of rods12 and 14. In some embodiments, rod stops are integrated into the spinalcorrection system to prevent one or more rods from disengaging from oneor more stabilizing anchors. In some other embodiments, one or more rodstops are positioned along one or more rods to prevent undesirablemovement (e.g., a specified type of movement or degree of movement suchas excessive flexion or extension, twist, rotation, or excessive bendingin one or more directions). In yet some other embodiments, one or morerod stops are positioned along one or more rods to selectively allowmovement (or a specified degree of movement) along certain regions ofthe rods, while preventing movement (or a specified degree of movement)along certain other regions of the rods. Thus, while the illustratedexample of FIG. 61 includes rod stops 35 positioned at each respectiveend of each of rods 12 and 14, it should be appreciated that rod stops35 may be positioned along each of rods 12 and 14 at any desirablelocation.

It should be appreciated that any number or quantity of transversecouplers 3200 may be implemented into the spinal correction system 1000.Therefore, a spinal correction system 1000 including a plurality oftransverse couplers 3200 may be tailored to the specific deformity orapical region of a patient's spinal column and thus may thus be appliedto a variety of patients in need of a variety of different spinalcorrections/de-rotations. Accordingly, the spinal correction system 1000is versatile in that it can be adapted or otherwise implemented tocorrect spinal column deformities of any encountered size or shape.

Moreover, while the above discussed spinal correction system embodimentsinclude a first rod having a first length, and a second, different rodhaving a second, different length (such as a shorter relative length),it should be appreciated that the above discussed features and systemscan be implemented in a spinal correction system which utilizes two rodsof substantially equal length. In some such embodiments, the two rodsextend along an entire length, or substantially along an entire length,of a spinal column 40. For example, the spinal correction system 1000 isillustrated in FIG. 62 includes a first rod 12 and second rod 14,wherein the second rod 14 is of a length similar to that of rod 12, andeach of the first rod 12 and the second rod 14 extend along an entirelength, or substantially along an entire length, of spinal column 40. Inthese embodiments, the spinal correction system provides for addedconstraints along the entire length (or substantially along the entirelength) of the spinal column 40. For example, the spinal correctionsystem 1000 illustrated in FIG. 62 provides that lateral translation ofthe vertebrae can be constrained at any (and potentially every) positionalong the spinal column. In fact, the spinal correction system 1000illustrated in FIG. 62 provides for a system that permits the vertebraeof the spinal column to change alignment and/or grow relative to eachand every other vertebra, while additionally providing for a system thatcan constrain laterally (medial-lateral, anterior-posterior),rotationally, and/or angularly zero, one, or more of the plurality ofvertebra 42 in the spinal column 40. Thus, such embodiments provide foradded stability and control of apical regions and deformities, as wellas for the spinal column as a whole.

In some embodiments, mobilization of the spinal column, in part or inwhole, can be effectuated while maintaining sufficient stabilizationthrough the use of one or more stabilization members. For example, FIG.63 illustrates a motion segment of a patient's spine (comprised of oneor more vertebra) in which stabilization members 5000A and 5000B eachspan the motion segment and allow for axial relative translation (andadditionally or alternatively in various embodiments, rotational and/orangular change) while providing stability, without fusing any vertebraof the motion segment to any other vertebra. In this illustrated exampleof FIG. 63, stabilization member 5000A is positioned along the secondside 40B of a patient's spinal column 40 and stabilization member 5000Bis positioned opposite to stabilization member 5000A along the firstside 40A of the patient's spinal column 40. While FIG. 63 illustratesthe use of a plurality of stabilization members (i.e., 5000A and 5000B),it should be appreciated that, in some embodiments, a singlestabilization member is utilized to provide stability. It should also beappreciated that, while the above-discussed stabilization members span asingle motion segment, in some embodiments, the above-discussedstabilization members are configured to span a plurality of motionsegments (such as any number of vertebrae in the patient's spinalcolumn).

In some embodiments, a stabilization member 5000 is coupled to at leasta first and a second stabilizing anchor (e.g., rod anchor). In someembodiments, at least one of the stabilizing anchors is configured toprevent substantial axial and lateral (lateral-medial andanterior-posterior) translation, as well as angular (pitch and yaw) androtational (roll) change. However, it should be appreciated that thefirst and second stabilizing anchors may take the form of (and thusoperate according to) any of the stabilizing anchors disclosed herein.In the illustrated example of FIG. 63, stabilization member 5000A iscoupled to stabilizing anchors 524 and 534 such that the stabilizationmember can change axial, angular, and rotational position relative tothe first stabilizing anchor 524, while being prevented from substantialaxial, lateral, angular, and rotational change relative to the secondstabilizing anchor 534.

Specifically, arm portion 5076A of stabilization member 5000A passesthrough a pivot point P1A defined by the first stabilizing anchor 524(see pivot point P1 and stabilizing anchor 18 discussed above), suchthat the stabilization member 5000A is prevented from substantiallateral translation (medial-lateral and/or anterior-posterior) at thepivot point P1A while maintaining freedom to slide axially (or translateaxially) through the pivot point P1A and change position angularly(e.g., pitch and yaw) and/or rotationally (e.g., roll) about the pivotpoint P1A. It should be appreciated that the first stabilization member524 may be mounted to (or otherwise secured to) a vertebra of thepatient's spine according to any of the embodiments disclosed herein.

As discussed above, in some embodiments, the stabilization member isadditionally constrained from substantially changing position axially,laterally, angularly, and rotationally relative to the secondstabilization member (see the discussion of stabilization member 20disclosed herein). For example, as is illustrated in FIG. 63, armportion 5076B of stabilization member 5000A is coupled to stabilizationmember 534 such that stabilization member 5000A is constrained fromsubstantially changing position axially, laterally, angularly, androtationally relative to the stabilization member 534. It should beappreciated that the second stabilization member 534 may be mounted to(or otherwise secured to) a vertebra (e.g., vertebral body) of thepatient's spine according to any of the embodiments disclosed herein.

By coupling a stabilization member with a plurality of stabilizinganchors such that the stabilization member maintains certain degrees offreedom (such as axial, angular, and/or rotational) with respect to oneof the stabilization members while being substantially fully constrainedrelative to the other stabilization member, the motion segment of thespinal column under correction can be stabilized while maintaining theability to grow. That is, the spinal correction system can stabilize adeformed segment of the spinal column in need of correction, whilepermitting that segment to appropriately expand, contract, flex, extend,and bend.

As discussed above, in some embodiments, a plurality of stabilizationmembers are utilized in association with a motion segment of a patient'sspine. In some embodiments (not shown), the second stabilization membertakes a form similar to the first stabilization member 5000A. In someother embodiments, the second stabilization member is dissimilar to thefirst stabilization member (e.g., the second stabilization member isfurther configured to be coupled with one or more additional componentsof a spinal correction system relative to the first stabilizationmember). For example, referring again to FIG. 63, stabilization member5000B is coupled to a first stabilizing anchor 516 and a secondstabilizing anchor 532 such that the stabilization member 5000B canchange axial, angular, and rotational position relative to the firststabilizing anchor 516, while being prevented from substantial axial,lateral, angular, and rotational change relative to the secondstabilizing anchor 532. Accordingly, it should be appreciated that, inthis illustrated example, stabilization member 5000B is coupled to firststabilizing anchor 516 and second stabilizing anchor 532 insubstantially the same manner as discussed above regarding stabilizationmember 5000A and stabilizing anchors 524 and 534. Moreover, thestabilization member 5000B is further configured to be coupled with afirst rod 120 (which is substantially similar to rod 12 disclosedherein).

Specifically, as is illustrated in FIG. 64, the stabilization member5000B includes a housing portion 5072. In some embodiments, the housingportion 5072 is substantially similar to housing portion 72 of the firststabilizing anchor 16 (discussed above). For example, among variousother features, the housing portion 5072 includes a body 5080 and asleeve insert 5082, the sleeve insert 5082 defining a pivot point P1B.In some embodiments, the sleeve insert 5082 is substantially sphericalin shape and the body 5080 forms a substantially spherical mating racefor receiving the sleeve insert 5082 (as is similarly discussed abovewith respect to body 80 and sleeve insert 82 of the first stabilizinganchor 16).

In some embodiments, the stabilization member 5000B is configured toslidably receive the rod 120 by way of the sleeve insert 5082 (as issimilarly discussed above with respect to stabilization member 16, oralternatively with respect to stabilization member 18). Specifically,upon assembly, the first rod 120 passes through the pivot point P1B suchthat the longitudinal axis of rod 120 at the pivot point P1B isgenerally concentric with the center of sleeve insert 5082. In someembodiments, the first rod 120 is operable to change angular positioning(pitch and yaw) about pivot point P1B. In some embodiments, similar tothose discussed above with respect to stabilizing anchor 16, first rod120 is substantially limited from rotational change about pivot pointP1B. Conversely, in some alternative embodiments, similar to thosediscussed above with respect to stabilizing anchor 18, the first rod 120is free to rotate about pivot point P1B. In any event, the first rod 120remains free to slide axially within the sleeve insert 5082, accordingto some embodiments.

Thus, in some embodiments, the spinal correction system 1000 providesthat the rod 120 may adopt multi-level positional changes about aplurality of pivot points relative to one or more vertebrae 42 of thespinal column 40, while constricting (either significantly orcompletely) any lateral movement. The inclusion of such additionallevels of movement provide for a spinal correction system that allowsfor more natural movement of the spinal column while still maintainingcontrol of apical regions and deformations under correction bypreventing substantial lateral (medial-lateral and/oranterior-posterior) translation.

It should also be appreciated that a plurality of different spinalcorrection system configurations including a plurality of stabilizationmembers are envisioned. The various configurations discussed below arefor illustrative purposes only and are not intended to be limiting.Thus, it should be appreciated that any suitable spinal correctionsystem configuration is envisioned.

In various embodiments, a spinal correction system configurationincludes a plurality of stabilization members, and at least a first,second, third, and fourth stabilizing anchor. In these embodiments, afirst one of the plurality of stabilization members is constrained fromsubstantial lateral (medial-lateral and anterior-posterior) movementrelative to the first stabilizing anchor, but is free to change axial,angular (pitch and yaw), and/or rotational (roll) position relative tothe first stabilizing anchor. The first stabilization member is furthersubstantially fully constrained relative to the second stabilizinganchor (i.e., constrained from substantial axial, lateral, angular, androtational positional changes).

Similarly, in these embodiments, a second one of the plurality ofstabilization members is constrained from substantial lateral(medial-lateral and anterior-posterior) movement relative to the thirdstabilizing anchor, but is free to change axial, angular (pitch andyaw), and/or rotational (roll) position relative to the thirdstabilizing anchor. The second stabilization member is furthersubstantially fully constrained relative to the fourth stabilizinganchor (i.e., constrained from substantial axial, lateral, angular, androtational positional changes).

In some embodiments, the first and second stabilizing anchors aremounted or secured to a first vertebra and a second vertebra (inferioror superior to the first vertebra), respectively, of a patient's spine.Additionally, in this embodiment, the third and fourth stabilizinganchors are mounted or secured to a third vertebra and a fourth vertebra(inferior or superior to the third vertebra), respectively, of thepatient's spine. In one embodiment, the first vertebra and the thirdvertebra are the same vertebra and the second vertebra and the fourthvertebra are the same vertebra. In another embodiment, the firstvertebra and the third vertebra are different. In another embodiment,the second vertebra and the fourth vertebra are different. In anotherembodiment, the first vertebra and the fourth vertebra are different. Inanother embodiment, the second vertebra and the third vertebra aredifferent. In yet another embodiment, the first vertebra, the secondvertebra, the third vertebra, and the fourth vertebra are eachdifferent. It should be appreciated that any suitable combination isenvisioned. It should also be appreciated that the stabilization memberis not limited to coupling to two stabilizing anchors, but may rather becoupled to any suitable number of anchors in any suitable configuration.Likewise, any suitable number of stabilization members may be utilizedin the spinal correction system.

It should also be appreciated that the spinal correction systemsdisclosed herein may be assembled according to any suitable method. Forexample, a stabilizing anchor (such as any anchor disclosed herein) maybe coupled to a rod prior to being secured to a vertebra of a patient'sspine. Conversely, a stabilizing anchor (such as any anchor disclosedherein) may be secured to a patient's spine prior to being coupled to arod. Likewise, a transverse coupler may be coupled to a rod at somepoint in time before, during, or after stabilizing anchors are coupledto the rod and/or secured to one or more of the patient's vertebrae. Insome embodiments, during assembly of a spinal correction disclosedherein, one or more components of the system (such as a stabilizinganchor) are coupled to a rod through end loading (e.g., by sliding thecomponent onto the rod, or alternatively sliding the rod through anopening, such as a sleeve, of the component) and subsequentlypositioning the component and rod at desired positions relative to oneanother. Conversely, as discussed above, a rod and component may becoupled together by top loading the rod onto the component (e.g., bypositioning the rod within a receiving surface of the component), as isdiscussed above with respect to FIGS. 20 and 21.

Various modifications and additions can be made to the exemplaryembodiments discussed without departing from the scope of the presentinvention. For example, while the embodiments described above refer toparticular features, the scope of this invention also includesembodiments having different combinations of features and embodimentsthat do not include all of the described features. Accordingly, thescope of the present invention is intended to embrace all suchalternatives, modifications, and variations as fall within the scope ofthe claims, together with all equivalents thereof.

1-26. (canceled)
 27. A method of correcting a spinal deformity of apatient's spine, the method comprising: securing a first rod anchor to afirst vertebra of the patient's spine; securing a second rod anchor to asecond vertebra of the patient's spine; coupling a first rod to thefirst rod anchor and the second rod anchor such that: the first rod islaterally constrained relative to the first rod anchor while being freeto slide axially and to change in at least pitch, yaw, and roll relativeto the first rod anchor; and the first rod is laterally constrainedrelative to the second rod anchor and is prevented from changing in atleast pitch, yaw, and roll relative to the second rod anchor; securing athird rod anchor to a third vertebra of the patient's spine; securing afourth rod anchor to a fourth vertebra of the patient's spine; andcoupling a second rod to the third rod anchor and the fourth rod anchorsuch that: the second rod is laterally constrained relative to the thirdrod anchor while being free to slide axially and to change in at leastpitch, yaw, and roll relative to the third rod anchor; and the secondrod is laterally constrained relative to the fourth rod anchor and isprevented from changing in at least pitch, yaw, and roll relative to thefourth rod anchor.
 28. The method of claim 27, further comprisingcoupling a first end of a transverse coupler to the first rod andcoupling a second end of the transverse coupler to the second rod suchthat the first rod and second rod are prevented from changing inalignment with respect to each other.
 29. The method of claim 27,wherein the first rod extends along a first side of the patient's spineand the second rod extends along a second side of the patient's spineopposite to the first side.
 30. The method of claim 27, wherein thefirst vertebra and the third vertebra are different, and wherein thesecond vertebra and the fourth vertebra are different.
 31. The method ofclaim 27, further comprising coupling a first end of a transversecoupler to the first rod and coupling a second end of the transversecoupler to the second rod such that at least one of the first rod or thesecond rod is free to change in at least pitch, yaw, and roll relativeto the transverse coupler.
 32. A method of correcting a spinal deformityof a spine, the method comprising: coupling a first rod to first andsecond rod anchors, the first rod anchor secured to a first vertebra ofthe spine and the second rod anchor secured to a second vertebra of thespine; coupling a second rod to third and fourth rod anchors secured tothe spine; securing a first end of a transverse coupler to the first rodbetween the first and second rod anchors with the first end in anunlocked configuration permitting the first rod to angulate in pitch andyaw relative to the transverse coupler while preventing lateraltranslation of the first rod relative to the transverse coupler;securing a second end of the transverse coupler to the second rodbetween the third and fourth rod anchors; and transitioning the firstend of the transverse coupler to a locked configuration in which thefirst rod is fixed relative to the transverse coupler.
 33. The method ofclaim 32, wherein securing the second end of the transverse coupler tothe second rod includes the second end being in an unlockedconfiguration such that the second rod is permitted to angulate in pitchand yaw relative to the transverse coupler while being prevented fromlateral translation of the second rod relative to the transversecoupler.
 34. The method of claim 33, wherein further comprisingtransitioning the second end of the transverse coupler to a lockedconfiguration in which the second rod is fixed relative to thetransverse coupler.
 35. The method of claim 32, further comprisingsecuring the third rod anchor to the first vertebra before coupling thesecond rod the third rod anchor.
 36. The method of claim 32, furthercomprising securing the third rod anchor to a third vertebra differentfrom the first and second vertebra before coupling the second rod thethird rod anchor.
 37. The method of claim 32, further comprisingsecuring the fourth rod anchor to the second vertebra before couplingthe second rod the fourth rod anchor.
 38. The method of claim 32,further comprising securing the fourth rod anchor to a fourth vertebradifferent from the first and second vertebra before coupling the secondrod the fourth rod anchor.
 39. The method of claim 32, wherein couplingthe first rod to the first and second rod anchors and coupling thesecond rod to the third and fourth rod anchors includes the first andsecond rod anchors being on a first side of the spine and the third andfourth rod anchors being on a second opposite side of the spine.
 40. Themethod of claim 32, wherein securing the first end of the transversecoupler to the first rod with the first end in the unlockedconfiguration permits the first rod to roll relative to the transversecoupler.
 41. The method of claim 32, wherein securing the first end ofthe transverse coupler to the first rod with the first end in theunlocked configuration permits the first rod to longitudinally translaterelative to the transverse coupler.